The Medical Letter on Drugs and Therapeutics
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In Brief: An Over-the-Counter Retinoid for Acne
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 Select a term to see related articles  Acne   Adapalene   Benzoyl peroxide   Differin   Epiduo   Retinoids 

Differin Gel 0.1% (Galderma), a topical formulation of the retinoid adapalene, will soon be available over the counter (OTC) for once-daily treatment of acne in patients ≥12 years old. It is the first topical retinoid to be approved for sale over the counter.

All topical retinoids normalize keratinization and appear to have anti-inflammatory effects; whether any one topical retinoid is more effective than any other is not clear. Many dermatologists now recommend topical retinoids for first-line treatment of acne; they can be used alone or in combination with antibiotics to treat both inflamed and noninflamed acne lesions, or for maintenance treatment. Retinoid/antimicrobial combinations are more effective than either component alone, particularly for patients with inflammatory lesions.1

Adverse effects of topical retinoids include dry skin, scaling, photosensitivity, erythema, burning, and pruritus. Although only small amounts of the drug are absorbed systemically following topical application, adapalene is classified as category C (teratogenic in rats; no adequate studies in pregnant women) for use during pregnancy.

Adapalene (Differin, and generics) is available by prescription in 0.1% gel, cream, and lotion formulations and in a 0.3% gel formulation. It is also available by prescription in combination with the oxidizing agent benzoyl peroxide (Epiduo; Epiduo Forte).

The cost of one 45-gram tube ranges from about $157 for generic adapalene to $580 for Differin.2 The cost of OTC Differin Gel 0.1% was not available at the time of publication.

  1. Drugs for acne. Med Lett Drugs Ther 2016; 58:13.
  2. Approximate WAC. WAC = wholesaler acquisition cost or manufacturer's published price to wholesalers; WAC represents a published catalogue or list price and may not represent an actual transactional price. Source: AnalySource® Monthly. September 5, 2016. Reprinted with permission by First Databank, Inc. All rights reserved. ©2016. www.fdbhealth.com/policies/drug-pricing-policy.
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