Aim: To assess the efficacy and safety of topical adapalene gel 0.1% as a treatment for acne vulgaris in black South African patients.
Background: African and other darker skin types represent a particular clinical challenge for dermatologists treating acne. In many cases, this is due to the higher risk of postinflammatory hyperpigmentation in patients with dark skin. Acne vulgaris is an extremely common dermatological problem among Africans and people of African descent worldwide. Few studies of any of the major acne therapies have been carried out in exclusively black populations, and relatively little is known about the specific responsiveness of black skin to these agents. The ideal acne treatment for black people would specifically target the inflammatory process, which so often results in hyperpigmentation. Topical retinoids do this to some degree, but they can be highly irritating and this in itself can provoke post-treatment hyperpigmentation.
Methods: An open-label study of adapalene 0.1% gel in 65 black South Africans, aged 12-30, for 12 weeks. Patients all had mild to moderate facial acne as defined by the Leeds scoring system; they were instructed to apply the medication once daily. Lesion counts and severity scores were assessed at 4, 8 and 12 weeks.
Results: A total of 44 subjects completed the trial and all three follow-up visits. Adapalene gel 0.1% showed clear efficacy against both inflammatory and non-inflammatory lesions. The drop in mean total facial-lesion count ranged from 46 to 72% between the first and last visit, and in most cases, there was clear improvement in cosmesis. In two-thirds of cases, patients experienced reductions in both number of hyperpigmented macules and density of hyperpigmentation.
Conclusion: Adapalene gel 0.1% is an effective, well-tolerated topical therapy for black patients. It is able to reduce both inflammatory and non-inflammatory lesions, as well as prevent and alleviate acne-associated hyperpigmentation.