Adapalene Gel for Acne Scars

I have had a number of requests for information on products that may help improve acne scars. Unfortunately, there are very few products that will make a significant difference in the appearance of acne scars. However, recent research suggests that there is one product that may help! Here is everything you need to know about adapalene gel for acne scars.

Why Does Acne Leave Scars

Acne is an inflammatory skin condition that affects up to 80% of 18-30-year-olds and 5% of people over 30 years-of-age , 90% of whom experience some degree of acne scarring.

Acne scars are caused by an imbalance in certain enzymes that regulate the amount of collagen produced during the healing of inflammatory acne. This leads to either too much or too little collagen being produced.

When too much collagen is produced it causes raised acne scars which are known as ‘hypertrophic scars’, however, when too little collagen is produced it causes pitted acne scars which are known as ‘atrophic scars’.

In 80-90% of cases, acne scars are atrophic and this is where adapalene gel for acne scars comes in.

What Is Adapalene Gel?

Adapalene is a retinoid, which is a catch-all term for vitamin A products. Retinoids increase the rate of skin cell turnover, which means that they increase the speed that new skin cells are made and travel to the surface of the skin. This can prevent dead skin cells from building up on the surface of the skin and blocking pores. They can also reduce the inflammation that is commonly experienced with acne.

Compared to tretinoin, the original topical retinoid, adapalene is a lot less irritating, more stable, and is better able to penetrate the oil glands which makes it particularly suitable to treat acne.

Lower concentrations of adapalene gel are available over the counter in some countries, but higher concentrations usually require a prescription.

Why Does Adapalene Gel Help Acne Scars?

Research suggests that, as well as being able to treat acne, adapalene can also treat the fine lines and wrinkles caused by sun damage. This suggests that adapalene has some effect on collagen production and may help improve the appearance of pitted acne scars.

In addition, topical retinoids are able to prevent important inflammatory pathways that are associated with acne and acne scarring. This means that as well as reducing existing scarring, they can prevent new scars from forming.

Some other forms of retinoid have also been able to improve the appearance of pitted acne scars. For example, in one research study, 0.1% tazarotene gel was as effective as microneedling treatments at improving the appearance of pitted acne scars.

Other research found that the combination of 0.025% retinoic acid and 12% glycolic acid improved pitted acne scars in 91% of patients after 12-weeks of use. Glycolic acid can also improve pitted acne scars when combined with retinaldehyde, as well as reducing the number of active spots, pimples, and red and brown acne marks (PIE & PIH).

Related Reading: Can You Use Glycolic Acid and Retinol Together?

Adapalene Gel for Acne Scars: The Research

Recent research has demonstrated that 0.3% adapalene gel can improve pitted acne scars after 24-weeks of use. In this study, adapalene was applied once a day for the first 4 weeks, then twice a day for the following 20 weeks, which differs to the usual recommended use of once-daily use.

Another clinical study investigated a combination of 0.3% adapalene gel and 2.5% benzoyl peroxide for the treatment of acne scars. After the 24-week study period, patients experienced a 30% reduction in the number of pitted acne scars.

Lower concentrations of adapalene gel are effective at preventing further acne scarring but do not appear to have much effect over existing acne scars after 24 weeks of use. However, lower concentrations tend to take longer to work and it is unclear whether any benefit would have been seen with a longer study period.

With all of these studies, adapalene gel was well-tolerated with patients experiencing little irritation throughout the study period.

How To Use Adapalene Gel for Acne Scars

The best way to use adapalene gel for acne scars is to see your doctor for a prescription (necessary for the 0.3% concentration used in the clinical studies) and follow their instructions.

Usually, this involves applying a pea-sized dollop of adapalene gel to the whole of your face every night. However, to begin with you may find that your skin is better able to tolerate adapalene gel if you build up slowly. This can reduce the risk of irritation and the severity of the ‘purging’ that can often be experienced when commencing retinoid treatment.

‘Purging’ refers to the acne flare-ups that are often experienced when starting a treatment that increases the rate of skin cell turnover. This can bring your usual break-outs to the surface of the skin faster which may make acne appear more severe. Purging can last from weeks to months but will eventually subside.

To reduce the risk of irritation and ‘purging’, you can begin by building up tolerance to adapalene gel by using the gel once a week for one-to-two weeks, then increasing use to twice a week for one-to-two weeks, then three times a week, and so on. Continue this pattern until you are able to use adapalene gel every night without irritation.

You can also start off by using lower concentrations to begin with. Lower concentrations take longer to work but are also less likely to cause irritation. Adapalene gel is available over the counter at 0.1% strength which can be a good place to start. However, as mentioned above, this strength currently only has evidence to support its ability to prevent acne scars and treat existing acne, although it has only been studied for a duration of 6 months.

Whichever adapalene gel you decide on, daily sunscreen use is an absolute must! This is because retinoids can increase the skins sensitivity to the sun, not to mention that UV radiation can make acne scarring worse by further breaking down collagen.

Where To Buy Adapalene Gel for Acne Scars

As mentioned above, only 0.1% adapalene gel is available to purchase over the counter. Differin gel is probably one of the most trusted brands of 0.1% adapalene gel and is readily available in many locations, including Amazon.com – hello one-day prime delivery!

Differin gel, itself, has been used in clinical research studies to investigate the effectiveness of adapalene gel at reducing acne (in fact one of the above-mentioned studies was performed using 0.3% Differin gel). 0.1% Differin gel can improve acne by 87% after 12-weeks of use.

If you currently have active acne breakouts that are beginning to scar, 0.1% Differin gel would be an excellent option, however, if you have more severe acne scarring then you really need to see your doctor or dermatologist for a prescription of 0.3% adapalene gel.

Differin adapalene gel is available in 15g which is approximately 30-days worth of once-daily application or 45g which can last for up to 90-days.

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La Roche-Posay also offer a 0.1% adapalene gel as part of their Effaclar range of products at a similar price for 45g.

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Additional Tips For Dealing With Acne Scars

1. Wear Sunscreen Daily – This is absolutely the best thing that you can do for your skin. Ultraviolet radiation from the sun is the number one cause of premature skin aging as it breaks down the collagen in the skin. In order to improve pitted acne scars, you need to maintain and increase the collagen within your skin – so forgoing sunscreen is a huge no-no!
2. Moisturize Skin – moisturizing is essential for all skin types, even acne-prone skin. Increasing skin hydration through the use of moisturizers and hydrating skincare ingredients makes skin appear more ‘plump’ which can instantly improve the appearance of fine lines and wrinkles. It is possible that your acne scars may appear worse than they are if your skin is dehydrated.
3. Exfoliate – While retinoids, such as adapalene gel, increase skin cell turnover, they don’t actually exfoliate the top layer of skin. For this reason, the effects of adapalene gel may be enhanced by adding a chemical exfoliant, such as glycolic acid, into your skincare routine – just be careful if you have sensitive skin as this combination may increase the risk of irritation.
4. Don’t Pick/Squeeze Spots – Picking and squeezing spots can increase inflammation and is more likely to lead to scarring than allowing spots to heal on their own. In addition, any open wounds, no matter how small, increase the risk of infection.
5. Seek Professional Help – While adapalene gel can offer some improvement for acne scars, it isn’t as effective as professional treatments such as lasers and microneedling. Your doctor or dermatologist will be able to discuss which professional treatments are best suited to you and your skin needs.
6. Be Patient – The results seen in the clinical studies were only evident after six months of adapalene gel use. In addition, for 20 weeks of the studies, the adapalene gel was used twice-daily which is more frequent than recommended. Lower strength adapalene gel, such as that available over the counter, will generally take even longer before seeing results.

Summary – Adapalene Gel for Acne Scars

Pitted acne scars are a common skin concern caused by the loss of collagen when inflammatory acne heals. Adapalene gel can help improve acne scars by boosting collagen production and increasing skin cell turnover, as well as by preventing inflammation and further acne scarring.

However, adapalene gel is not a quick fix for acne scars and it is likely to be at least six months before any improvements are seen.

For more detailed information on acne scars and what treatment options are available, please see here: Acne Scars vs Acne Marks.

References

1. Jacob, C., Dover, J. & Kaminer, M. (2001). ‘Acne scarring: a classification system and review of treatment options.’, J Am Acad Dermatol., 45(1), 109-117. Available at: https://www.ncbi.nlm.nih.gov/pubmed/11423843/
2. Werschler, W., Herdener, R., Ross, V. & Zimmerman, E. (2015). ‘Treating Acne Scars: What’s New?’, J Clin Aesthet Dermatol., 8(Supp 8), 2-8. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4570086/
3. Connolly, D., Vu, H., Mariwalla, K. & Saedi, N. (2017). ‘Acne Scarring – pathogenesis, evaluation, and treatment options’, J Clin Aesthet Dermatol., 10(9), 12-23. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749614/
4. Piskin, S. & Uzunali, E. (2007). ‘A review of the use of adapalene for the treatment of acne vulgaris’, Ther Clin Risk Manag., 3(4), 621-624. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2374937/
5. Kang, S., Goldfarb, M., Weiss, J. et al. (2003). ‘Assessment of adapalene gel for the treatment of actinic keratosis and lentigines: A randomized trial’, J Am Acad Dermatol., 49(1), 83-90. Available at: https://pubmed.ncbi.nlm.nih.gov/12833014/
6. Afra, T., Ramzi, M., Narang, T. et al. (2018). ‘Topical Tazarotene gel 0.1%, as a novel treatment approach for atrophic postacne scars: A randomized active-controlled clinical trial’, JAMA Facial Plast Surg., 21(2), 125-132. Available at: https://jamanetwork.com/journals/jamafacialplasticsurgery/article-abstract/2714234
7. Chandrashekar, B., Ashwini, K., Vasanth, V. & Navale, S. (2015). ‘Retinoic acid and glycolic acid combination in the treatment of acne scars’, Indian Dermatol Online J., 6(2), 84-88. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4375771/
8. Dreno, B., Katsambas, A., Pelfini, C. et al. (2007). ‘Combined 0.1% retinaldehyde/ 6% glycolic acid cream in prophylaxis and treatment of acne scarring’, Dermatology, 214(3), 260-267. Available at: https://www.ncbi.nlm.nih.gov/pubmed/17377389/
9. Loss, M., Leung, S., Chien, A. et al. (2018). ‘Adapalene 0.3% gel shows efficacy for the treatment of atrophic scars’, Dermatol Ther., 8(2), 245-257. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002315/
10. Tan, J., Tanghetti, E., Baldwin, H., Stein Gold, L. & Lain, E. (2019). ‘The role of topical retinoids in prevention and treatment of atrophic acne scarring: Understanding the importance of early effective treatment’, J Drugs Dermatol., 18(3), 255-260. Available at: https://www.ncbi.nlm.nih.gov/pubmed/30909329
11. Dreno, B., Tan, J., Martel, P. & Bissonnette, R. (2017). ‘Adapalene 0.1%/benzoyl peroxide 2.5% gel reduces the risk of atrophic scar formation in moderate inflammatory acne: a split-face randomized controlled trial’, J Eur Acad Dermatol Venereol, 31(4), 737-742. Available at: https://www.ncbi.nlm.nih.gov/pubmed/27790756