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Topical retinoid Pregnancy: Avoid — though systemic absorption is minimal, all retinoids are class-teratogenic. Use azelaic acid or topical erythromycin in pregnancy.

Adapalene

Brand names: Differin, Epiduo (with benzoyl peroxide)

Adult dose

Dose: Apply a thin layer to affected area once daily at night
Route: Topical
Frequency: Once daily (evening)
Wash skin and pat dry before application. Avoid eyes, lips, mucous membranes, broken skin.

Clinical pearls

  • First-line topical retinoid for mild–moderate acne (NICE NG198) — better tolerated than tretinoin or isotretinoin gel.
  • Effects take 8–12 weeks — counsel about realistic timelines and initial flare.
  • Combination Epiduo (adapalene + benzoyl peroxide) addresses comedones and inflammation simultaneously — preferred over monotherapy in NICE NG198.
  • Pea-sized amount for whole face is sufficient — over-application increases irritation without benefit.
  • Continue maintenance therapy 2–3 nights/week long-term to prevent relapse after clearance.

Contraindications

  • Pregnancy (relative — minimal systemic absorption but retinoid class teratogenicity)
  • Severe eczema or seborrhoeic dermatitis on the same area
  • Hypersensitivity to adapalene or excipients
  • Children under 12 (limited data)

Side effects

  • Erythema, dryness, scaling — peaks at 2–4 weeks
  • Burning, stinging on application
  • Photosensitivity
  • Initial 'purge' / acne flare in first 2–4 weeks (counsel patient — do not stop)
  • Hypopigmentation / hyperpigmentation in dark skin (rare)

Interactions

  • Other irritants (benzoyl peroxide unless combined product, salicylic acid, glycolic acid): apply at different times of day
  • Sun exposure: increased photosensitivity — recommend daily SPF

Monitoring

  • Treatment response at 8–12 weeks

Reference: BNF 90; SmPC Differin / Epiduo; NICE NG198 (Acne vulgaris 2021); BAD Acne Guideline. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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