Treatment of moderate papulopustular acne with systemic doxycycline and the novel fourth-generation topical retinoid trifarotene

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Acne vulgaris is a prevalent chronic inflammatory skin disorder that significantly impacts patients’ quality of life and necessitates effective and safe therapeutic strategies.

This article presents an analysis of current scientific sources and clinical experience regarding the use of the novel fourth-generation topical retinoid trifarotene (50 μg/g cream) in combination with systemic doxycycline for the treatment of moderate to severe papulopustular acne. A systematic review of scientific data highlights the unique mechanisms of trifarotene, particularly its high selectivity for the retinoic acid receptor gamma (RAR-γ). The antibacterial and anti-inflammatory properties of doxycycline, which enhance trifarotene’s therapeutic effects by inhibiting Cutibacterium acnes proliferation and reducing inflammatory cytokine production, are also discussed. The authors share their clinical experience, demonstrating the high efficacy and favorable safety profile of this combined treatment in patients with moderate facial and truncal acne.

The combination of trifarotene (50 μg/g) and systemic doxycycline offers proven clinical benefits, good tolerability, and a low risk of adverse events. Collective evidence from both Russian and international studies supports the recommendation of trifarotene and doxycycline combination therapy as an effective and safe approach with strong potential for widespread implementation in contemporary dermatologic practice.

作者简介

Elena Snarskaya

The First Sechenov Moscow State Medical University (Sechenov University)

Email: snarskaya-doc@mail.ru
ORCID iD: 0000-0002-7968-7663
SPIN 代码: 3785-7859

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Moscow

Olga Olisova

The First Sechenov Moscow State Medical University (Sechenov University)

Email: olisovaolga@mail.ru
ORCID iD: 0000-0003-2482-1754
SPIN 代码: 2500-7989

MD, Dr. Sci. (Medicine), Professor, Corresponding Member of the Russian Academy of Sciences

俄罗斯联邦, Moscow

Anna Bratkovskaya

The First Sechenov Moscow State Medical University (Sechenov University)

编辑信件的主要联系方式.
Email: annabratk24@gmail.com
ORCID iD: 0000-0002-7284-9113
SPIN 代码: 6012-7555
俄罗斯联邦, Moscow

参考

  1. Clinical Guidelines. Acne vulgaris. Russian Society of Dermatovenerologists and Cosmetologists; 2020. Available at: https://www.rodv.ru/klinicheskie-rekomendacii Accessed: Dec 12, 2024.
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  3. Issa N, Alexis A, Baldwin H, et al. Recommendations to improve outcomes in acne and acne sequelae: A focus on trifarotene and other retinoids. Dermatol Ther (Heidelb). 2025;15(3):563–577. doi: 10.1007/s13555-025-01344-y
  4. Del Rosso JQ, Bikowski JB, Baum E, et al. A closer look at truncal acne vulgaris: Prevalence, severity, and clinical significance. J Drugs Dermatol. 2007;6(6):597–600.
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  8. Ju Q, Fan WX, Gu J, et al. Chinese guidelines for the management of acne vulgaris: 2019 Update. Int J Derm Venereol. 2019;2(3):129–138. doi: 10.1097/JD9.0000000000000043
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  13. Tan J, Chavda R, Baldwin H, Dreno B. Management of acne vulgaris with trifarotene. J Cutan Med Surg. 2023;27(4):368–374. doi: 10.1177/12034754231163542
  14. Dreno B, Chavda R, Julia V, et al. Transcriptomics analysis indicates trifarotene reverses acne-related gene expression changes. Front Med (Lausanne). 2021;8:745822. doi: 10.3389/fmed.2021.745822
  15. Tan J, Thiboutot D, Popp G, et al. Randomized phase 3 evaluation of trifarotene 50 μg/g cream treatment of moderate facial and truncal acne. J Am Acad Dermatol. 2019;80(6):1691–1699. doi: 10.1016/j.jaad.2019.02.044
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2. Fig. 1. Patient B., 22 years old, diagnosed with moderately severe vulgar acne: a ― papulo-pustular multiple rashes on the facial skin before treatment; b ― complete regression of rashes after 5 months of therapy. [Photo from the archive of the I.M. Sechenov First Moscow State Medical University. Published for the first time with the permission of the administration of the institution].

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3. Fig. 2. Patient A., 20 years old, diagnosed as “Vulgar acne of medium severity with a tendency to scar formation”: a ― skin condition before treatment; b ― 90% regression of rashes by the end of the 12th week of treatment. [Photo from the archive of the I.M. Sechenov First Moscow State Medical University. Published for the first time with the permission of the administration of the institution].

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4. Fig. 3. Patient B., 19 years old, diagnosed as “Vulgar acne of medium severity, postacne symptom complex”: a ― skin condition before treatment; b ― regression of rashes by the end of the 12th week of treatment, residual phenomena in the form of moderately pronounced postacne symptom complex. [Photo from the archive of the I.M. Sechenov First Moscow State Medical University. Published for the first time with the permission of the administration of the institution].

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5. Fig. 4. Patient G., 19 years old, diagnosed as “Vulgar acne of medium severity, widespread with localization on the skin of the back and chest”: a ― skin condition before treatment; b ― regression of rashes by 75% after 8 weeks of treatment. [Photo from the archive of the I.M. Sechenov First Moscow State Medical University. Published for the first time with the permission of the administration of the institution].

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6. Fig. 5. Patient D., 23 years old, diagnosed as “Vulgar acne of medium severity, widespread with localization on the back skin”: a ― papulo-pustular multiple rashes on the back skin before treatment; b ― marked clinical remission by the end of the 4th month of treatment. [Photo from the archive of the I.M. Sechenov First Moscow State Medical University. Published for the first time with the permission of the administration of the institution].

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