Adapalene - Uses, Dosage, and Warnings

Overview

Adapalene is a topical gel used to treat acne and was first approved in 1996 by the Food Drug Administration for use in patients over 12 years of age. The 0.1 percent gel is available over the counter, and other dosage forms can be availed with a prescription. It helps with acne treatment and is a form of retinoid like Tretinoin.

How Does Adapalene Work?

Adapalene brings about changes in cellular keratinization and the inflammatory response. This is because the drug inhibits the lipoxygenase activity and the oxidative mechanism of arachidonic acid. Arachidonic acid is a fatty acid comprising four methylene-interrupted cis double bonds, which is rapidly converted into metabolites like cyclooxygenase to produce prostaglandins, thromboxanes, and prostacyclin. The acid mainly contributes to the inflammatory response and intercellular pro-inflammatory mediators, thereby resulting in pain exacerbation.

Uses:

The drug is highly recommended for treating acne-related skin conditions. It has been proven to be very effective in treating acne when used in recommended quantities. It prevents acne formation and helps to heal the skin.

Dosage:

The drug is available in various forms, like gel and cream. Depending on the severity of the acne, the doctor may prescribe a dose suitable for the patient. The gel or cream is to be applied after thoroughly cleansing the skin and drying it. Mostly, it is recommended at night times. It is important to apply sunscreen while using any active ingredients on the skin as it could damage the new cell formation.

Warnings:

• Allergies - The drug could cause allergic reactions; hence, it is essential to inform the doctor priorly regarding any previous history of allergic reactions to any medication or food.

• Pediatric - Studies regarding the drug have only been conducted in adults, and there is no evidence of comparing the drug use in children. In teenagers, the drug does not cause many side effects.

• Geriatric - The exact use of the drug in elderly individuals is not clearly known. There are not many supporting studies to prove the drug efficacy in the elderly. Older individuals are very unlikely to develop acne.

• Breastfeeding - The use of the drug in women for determining the risk for infants are still being studied. It is better to understand the potential risks before starting the drug.

For Patients

What Is Acne?

A type of skin condition that occurs when the hair follicles are clogged with oil and dead skin is called acne. It causes pimples, whiteheads, and blackheads. It is very common in teenagers, although it affects individuals of different ages. Although effective acne treatment is available, acne can still be persistent. Bumps and pimples caused due to acne may heal slowly or may result in acne scars, causing permanent skin damage. During acne, there is a high chance of it spreading to other areas of the body. Acne is commonly seen in the face and neck region. Sometimes, acne can also be seen in the trunk region, which could be due to hair infections or dandruff, or a fungal infection. Some of the common factors responsible for acne are mentioned below:

• Excess oil or sebum.

• Bacteria.

• Inflammation of the skin.

• Hair follicles clogged with oil.

• Dead skin cells.

Since most sebaceous glands are present in the face, forehead, upper back, and chest, the skin over these areas is more prone to acne. If the wall of the hair follicle bulges, it may result in a whitehead. If the plug opens to the surface, it may cause blackheads. A blackhead generally appears like dirt stuck in the pore. But the pore is infected with bacteria and oil, which turns brown in color when exposed to air. Some of the factors that trigger acne are:

• Hormonal Changes - The hormone androgen increases in both boys and girls during the time of puberty. It causes the sebaceous glands to enlarge, resulting in more sebum production. The hormonal changes in women during mid-life may also cause acne breaks out.

• Diet - Consuming certain foods that are rich in carbohydrates, like bread, chips, and bagels, may worsen acne. A restricted diet rich in fruits and vegetables can help maintain the skin. In addition, consuming plenty of water may help to remove unwanted toxins from the skin and boosts collagen, which maintains the skin's elasticity and keeps it moisturized.

• Stress - Stress does not cause acne; however, it aggravates acne. Also, people tend to take poor care of their skin and overall health during stress.

Learn More About Adapalene:

When and How Often to Take Adapalene?

The gel or cream is to be applied exactly as recommended by the dermatologist. Avoid using excessive amounts as it may damage the skin. Overuse of the drug could exacerbate the existing acne, resulting in breakouts. Usually, applying it once or twice a day, as recommended by the dermatologist, would be sufficient.

How Effective Is Adapalene?

Adapalene is the most effective drug used for treating acne. It has been used for mild to severe acne and has proven to treat them effectively. A drug is a form of retinoid that acts by inhibiting the existing acne and repairing the skin barrier. It protects the skin from being affected by acne. Many studies have proven to show that Adapalene is one of the most successful treatments.

Things to Inform The Doctor Before They Prescribe Adapalene:

Before taking the drug, inform the doctor regarding any previous history of allergic reactions to any medications. Also, carry the medical history and family history as it helps the doctor to assess the cause of acne and if there are any hereditary or genetic reasons.

Starting Adapalene:

How to Take Adapalene?

The drug is available as a topical medication. Wash the face thoroughly and pat dry it. Take the required amount of Adapalene gel and slowly apply it over the areas of damaged skin. Use the fingertips to apply the cream gently. Make sure the hands are clean before applying the drug to avoid any cross-contamination. Do not use it more often than recommended by the doctor. Overuse of the drug could result in skin irritation. Avoid using the drug on sunburned skin or open wounds. Also, avoid applying it around the eyes, lips, and nose.

What Are the Side Effects of Adapalene?

Some of the side effects are commonly observed in individuals using Adapalene gel. They are mentioned below:

• Redness.

• Itching.

• Scaling.

• Mild burning.

• Worsening of acne.

• Dryness.

The side effects usually occur within the first two weeks of using the medication. They usually decrease with continued use. If the side effects last longer, then it is important to inform the doctor promptly.

Dietary Alterations:

Since the drug is given for topical application, no dietary changes are required. Dietary modifications may be suggested to limit acne, like avoiding fatty substances. Unless specified by the doctor, no dietary changes are required.

What Should Be Done When a Dose Is Missed?

It is always better to follow a regular schedule or set an alarm or reminder to avoid missing a dose. In case of a missed dose, follow the regular schedule without any alterations. Never overdose on the drug, as it may result in unwanted complications.

What Should Be Done to Treat Adapalene Overdose?

Adapalene is a topical cream, and it is extremely rare to overdose on the drug. There are chances of patients applying the cream quite often than recommended for better skin results. But this could cause skin irritation and allergic reactions. Sticking to the recommended dosage can be more beneficial and successful.

How to Store Adapalene?

Adapalene is available in the gel form in a tube. Store the tube in a dry place and avoid direct sunlight exposure. Also, keep it away from children and pets as it could be unsafe. Keep away from freezing, and do not keep any outdated medicine.

How to Handle Adapalene?

Just like any topical agent, the gel comes in a tube. Just dispense the required amount in the fingertips and gently apply it to the specified areas. Do not squeeze the tube harshly, as more drugs could be dispensed, which could be a waste.

How to Dispose of Adapalene?

Since the drug is specifically used for acne treatment, the doctor may advise using it for a week or month. So the remaining tube should be disposed of safely to avoid any biohazard. It is always safe to contact the local take-back program to dispose of any medical waste effectively. Also, it is important to prevent others from using the medication as there could be chances of contamination. Do not flush down the contents of the tube in the toilet, as most wastewater is recycled and used.

Avoid Self-Medication:

Consulting a dermatologist is always safer when it comes to skin treatment. It is important to understand the type of skin before applying any topical agents. The skincare routine should always be minimal and gentle on the skin. So applying any topical agents on the skin should be done after having a thorough knowledge of the drug. Avoid self-medicating the drug without a doctor's prescription, as it could be unsafe.

Staying On Adapalene

Tips to Stay On Track:

Apply the gel every day at the same time before bed or in the morning so that the process is done daily. Using the drug daily has beneficial effects and helps to get rid of acne with regular use. Staying motivated during the treatment is important, as skin treatments usually take at least three months to repair and heal the skin completely. In the initial phases of treatment, individuals can notice the skin infection or acne is less progressing, as the drug first limits the disease progression and helps heal the skin damage.

For Doctors

Indication:

Adapalene is prescribed for the following medical conditions:

• Verrucae (grainy growths on the heel).

• Molluscum contagiosum (a viral skin infection).

• Darier disease (wart-like blemishes in the body).

• Photoaging (skin aging caused due to sun exposure).

• Pigmentary disorder (presence of melanin pigmentation).

• Actinic keratosis (skin patches due to sun exposure).

• Alopecia areata (auto-immune disorder causing hair loss).

• Acne.

Mechanism of Action:

The drug inhibits the lipoxygenase activity and the oxidative mechanism of the inflammatory triggering arachidonic acid. This helps reduce the skin irritation caused by applying Adapalene gel. It stops the pimples from forming beneath the skin surface and prevents the progression of existing acne. It completely heals and treats acne. However, some acne tends to leave a scar which is managed later.

• Absorption: The drug is absorbed through the skin. However, the rate of skin absorption is very low. Only trace amounts of the substance are found in the plasma of acne patients.

• Elimination: The drug is eliminated through the biliary route.

• Toxicity: Adapalene gel rarely causes toxicity. However, overuse may cause allergic reactions and may delay the treatment outcomes.

Ingredients:

• Active Ingredient: Adapalene gel comprises 0.3 percent Adapalene in the active form and 0.3 percent aqueous gel.

• Inactive Ingredients: The inactive ingredients are carbomer 940, edetate disodium, sodium hydroxide, purified water, and propylene glycol.

Dosage and Forms:

Adapalene is generally available in three forms, which are mentioned below:

• Adapalene gel.

• Adapalene lotion.

• Adapalene pledget.

Considerations for Administration:

Before recommending Adapalene gel for acne treatment, it is better to do a patch test on the skin to observe any allergic reactions. Once it is known that the drug has no side effects or allergies, the patients may proceed using the drug as suggested by the dermatologist.

Other Specifications:

Adapalene in Pregnant Women: Adapalene is a topical gel; hence, it usually does not affect pregnant women or cause any complications to the unborn child. Hence, it is safe to use during pregnancy.

Adapalene in Lactating Women: The drug is not available in an oral formulation. So there are rare chances of the drug affecting the lactating mother or the presence of the drug in the mother’s milk. It is just applied to the skin.

Adapalene in Pediatric Patients: Most acne tends to appear in children during the time of puberty. Children may suffer from different forms of skin infection, but they rarely have acne. Hence, the drug is rarely suggested in pediatric patients.

Adapalene in Geriatric Patients: In contrast, geriatric patients may also have fewer sebaceous glands as they age. So the limited sebaceous glands rarely cause acne. So the drug is not used as much in elderly individuals as in adults.

Adapalene in Renal Impairment Patients: Most drugs are metabolized in the kidneys, so they should be carefully administered in patients with pre-existing medical conditions. Adapalene does not affect renal-impaired patients as it is applied as a topical cream.

Adapalene in Hepatic Impairment Patients: Patients with hepatic impairment are not affected by Adapalene gel; hence it is safe to use.