Brand name: Differin
Drug class: Keratolytic Agents

Medically reviewed by Drugs.com on May 10, 2024. Written by ASHP.

Introduction

Retinoid; synthetic naphthoic acid-derivative.^{7 8 10 11 12 13 14 15 16 17 18 19 20 22}

Uses for Adapalene (Topical)

Acne Vulgaris

Treatment of acne vulgaris.^{1 4 5 6 7 11 12 13 14 16 17 18 19 20 21 22 31 32}

Adapalene (Topical) Dosage and Administration

Administration

Topical Administration

Apply a thin film to skin as a cream, gel, or solution.^{1 4 5 7 11 12 13 16 17 18 19 20 21 22 31 32}

Cleanse and dry the affected areas prior to application.^{1 31 32}

Do not apply to eye(s), lips, angles of nose, or mucous membranes.^{1 31 32}

A transient feeling of pruritus or burning may occur immediately after application.^{1 12 31 32} If increased sensitivity or irritation occurs, reduce frequency of application or, depending on the severity, discontinue use.^{1 31 32}

Apparent exacerbation of acne that may occur during early weeks of therapy is attributable to the drug’s action on previously unseen lesions; do not discontinue.^{1 31 32}

Excessive use does not increase therapeutic effects and may produce marked erythema, peeling, and discomfort.^{1 31 32}

Pledgets

Remove single-use pledget applicators from foil immediately before use, use once, and then discard; do not use if seal is broken.³¹

Dosage

Pediatric Patients

Acne Vulgaris

Topical

Children and adolescents ≥12 years of age: Apply once daily in the evening at bedtime.^{1 12 31 32}

Improvement usually detectable within 8–12 weeks.^{1 31 32}

Adults

Acne Vulgaris

Topical

Apply once daily in the evening at bedtime.^{1 12 31 32}

Improvement usually detectable within 8–12 weeks.^{1 31 32}

Prescribing Limits

Pediatric Patients

Acne Vulgaris

Topical

Children and adolescents ≥12 years of age: most reported experience to date has been for treatment periods that did not exceed 12 weeks.^{4 5 6 12 22}

Adults

Acne Vulgaris

Topical

Most reported experience to date has been for treatment periods that did not exceed 12 weeks.^{4 5 6 12 22}

Cautions for Adapalene (Topical)

Contraindications

• Known hypersensitivity to adapalene or any ingredient in the formulation.^{1 31 32}

Warnings/Precautions

Sensitivity Reactions

Photosensitivity

Increased risk for sunburn; minimize exposure to sunlight or artificial UV irradiation sources (e.g., sunlamps).^{1 31 32}

Use caution in patients subjected to considerable occupational sun exposure or with inherent sun sensitivity; use of sunscreen products (SPF 15 or greater) and protective clothing over treated areas recommended when exposure cannot be avoided.^{1 31 32}

Avoid concomitant use of photosensitizing agents.³³ (See Interactions.)

Use not recommended in patients with sunburn until full recovery occurs.^{1 31}

Other Sensitivity Reactions

Discontinue therapy if sensitivity reaction or chemical irritation occurs.^{1 31 32}

General Precautions

Dermatologic Effects

Erythema, dryness, scaling, burning, or pruritus may occur.^{1 31 32} If increased sensitivity or irritation occurs, use less frequently or, depending on the severity of the reaction, discontinue.^{1 31 32}

Do not apply to cuts, abrasions, or eczematous or sunburned skin.^{1 31 32} (See Photosensitivity under Cautions.)

Facial Cleansing

Use of mild or soapless cleanser is recommended; use medicated or drying soaps and abrasive soaps and cleansers with caution.^{1 31 32}

Cosmetic Agents or Processes

Avoid use of irritating cosmetics, other preparations, or processes (e.g., electrolysis) that might dry or irritate the skin.³³ (See Interactions.)

Environmental Stimuli

Possible increased skin irritation in patients exposed to environmental extremes (e.g., wind, cold).^{1 31 32}

Dry Skin

Use moisturizers if necessary; avoid preparations containing alpha hydroxy or glycolic acids.³²

Specific Populations

Pregnancy

Category C.^{1 31 32}

Lactation

Not known whether adapalene is distributed into milk.^{1 31 32} Use caution.^{1 31 32}

Pediatric Use

Safety and efficacy not established in children <12 years of age.^{1 31 32}

Geriatric Use

Insufficient experience in controlled clinical studies in patients ≥65 years of age to determine whether geriatric patients respond differently to adapalene than younger adults.³² However, clinical experience generally has not revealed age-related differences.³²

Common Adverse Effects

Erythema, scaling, dryness, pruritus, burning/stinging.^{1 31 32}

Drug Interactions

Specific Drugs

Other Topical Preparations

Potential pharmacodynamic interaction (increased skin irritation).^{1 31 32} Avoid concurrent use of topical preparations with high concentrations of alcohol, menthol, spices, or lime (e.g., lotions, astringents, perfume); irritating cosmetics (e.g., toners, peeling [desquamating] agents); permanent wave solutions; or hair depilatories or waxes.^{1 31 32 33}

Adapalene (Topical) Pharmacokinetics

Absorption

Bioavailability

Minimally absorbed following topical application.^{1 31 32}

Elimination

Elimination Route

Eliminated principally by biliary excretion.^{1 31 32}

Stability

Storage

Topical

Cream, Gel, Solution

20–25°C.^{1 31 32}

Protect cream from freezing.³²

Store solution upright in tight container.³¹

Actions

• Actions similar to those of other retinoids (e.g., isotretinoin, tretinoin) but more potent anti-inflammatory activity in vitro and in vivo.^{1 4 5 6 9 13 15 16 17 19 23 24 31}

• Relatively selective affinity for specific nuclear retinoic acid receptor (RAR) proteins (e.g., RARβ, RARγ) that appear to enhance gene transcription.^{5 6 7 23 24}

• Exact mechanism(s) of action not elucidated.^{1 4 5 6 9 13 15 16 17 19 31} Appears to affect expression of genes that modulate follicular keratinization^{5 19 22} and cell (e.g., epithelial) differentiation,^{1 4 5 6 9 10 13 15 19 22 23 31} which result in inhibition of corneocyte accumulation and cohesion and reduction in inflammatory and noninflammatory acne lesions.^{1 6 11 12 22 23 24 31}

Advice to Patients

• Importance of clinicians instructing patients about proper use of the drug.^{1 31 32}

• Importance of continuing therapy in early weeks, even if acne initially appears to worsen.^{1 31 32}

• Risk of photosensitivity; importance of using sunscreens and wearing protective clothing over treated areas.^{1 31 32}

• Importance of avoiding contact with eyes, lips, angles of nose, or mucous membranes.^{1 31 32}

• Importance of not applying adapalene to cuts, abrasions, or eczematous or sunburned skin.^{1 31 32}

• Importance of women informing clinicians if they are or plan to become pregnant or to breast-feed.^{1 31 32}

• Importance of patients informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs.^{1 31 32}

• Importance of informing patients of other important precautionary information.^{1 31 32} (See Cautions.)

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Frequently asked questions

• What are the most common skin conditions? (with photos)
• Can Tazorac and Differin be used together?

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