Trifarotene clears acne battle scars

Individuals dealing with the stubborn scars and hyperpigmentation left behind by acne may find benefit in trifarotene cream – the newest among the new generation of topical retinoids approved for acne treatment, according to the findings of two vehicle-controlled, phase IV studies presented at AAD 2024.

Atrophic scarring and acne-induced hyperpigmentation affect patients’ lives and often outlive the causative acne lesion. [J Dermatol 2016;43:826-828] “[Managing these sequelae] is thus an important consideration in acne therapy … Treatment addressing both acne lesions and sequelae is likely to improve long-term outcomes,” said the researchers.

START: Atrophic acne scarring

Using a split-face design, the START* trial evaluated treatment with trifarotene cream 0.005% in 121 individuals with moderate-to-severe acne and symmetrical distribution of atrophic acne scars. The treatment was administered on top of a regular skincare regimen comprising a gentle cleanser, moisturizer, and sunscreen. [AAD 2024, abstract 53113]

Trifarotene treatment significantly improved scar counts compared with the vehicle cream, with differences becoming apparent as early as week 2: the mean absolute change from baseline in total atrophic acne scar count in the trifarotene arm was –0.9, whereas with the vehicle, the corresponding count was 0.4. A comparison between arms yielded a p-value of 0.0248. Trifarotene continued to have the upper hand over the vehicle through week 24 (–5.9 vs –2.7; p≤0.0001).

Of note, the mean total atrophic scars at baseline was similar between the trifarotene and the vehicle arms (11.4 vs 11.6).

There were also significant differences between the trifarotene and the vehicle arms in terms of scar global assessment success at week 12 (14.9 percent vs 5.0 percent; p<0.05) and week 24 (31.3 percent vs 8.1 percent; p<0.001).

With regard to acne, the investigator global assessment success rate was higher in the trifarotene vs the vehicle arm (63.6 percent vs 31.3 percent; p<0.0001), as were the reductions in lesion counts (70 percent vs 45 percent [total] and 76 percent vs 48 percent [inflammatory]).

“[Taken together,] the number of hypertrophic scars was reduced by ~50 percent, [and] the risk of scar formation was mitigated by reducing inflammatory lesions,” the researchers explained.

LEAP: Acne-induced hyperpigmentation

In the LEAP** study, 123 individuals with moderate acne and moderate/marked post-inflammatory hyperpigmentation were randomized in a 1:1 ratio to either the active arm (trifarotene cream 0.005%) or a vehicle arm.

At week 12, overall disease severity (ODS) rapidly dropped with trifarotene than with the vehicle cream (–1.6 vs –1.1; p=0.03), translating to accelerated pigmentation clearance with the former, the researchers noted. By week 24 however, ODS was similar between arms.

Nonetheless, reduction in PAHPI*** (size, intensity, number) was nearly twofold greater with trifarotene than with vehicle at week 12 (mean percent change in total PAHPI scores from baseline –8.4 vs –4.5). Week 24 saw further reductions, with trifarotene still trumping the vehicle cream (mean percent change in total PAHPI scores from baseline –18.9 vs –11.3; p=0.0093).

Although not an endpoint in LEAP, several patient photographs reflected reductions in macular erythema, the researchers added. “Thus, future assessment of improvement in macular erythema with trifarotene treatment of acne is warranted.”

Rapid improvements, effective acne control

Evidence shows several mechanisms by which trifarotene may disrupt acne pathogenesis and improve acne-related scarring and pigmentation. [Br J Dermatol 2018;179;442-456; Front Med (Lausanne) 2021;8:745822]

START and LEAP build on these evidence by demonstrating the ability of trifarotene to deliver rapid improvements in acne sequelae and provide effective acne control, the researchers noted.

Trifarotene was also well tolerated, with higher tolerability scores than the vehicle, they added.

Taken together, the results provide important data for real-world use of trifarotene cream.