Retinoids remain the most effective topical treatment we have for acne. They work to help both clear the active spots themselves and improve the skin texture and dark marks that acne leaves behind. Better still, they can also help treat other skin conditions including skin ageing. Tretinoin and adapalene are the two most popular prescription options in the UK, with decades of evidence behind them. Aklief is a newer prescription retinoid. It’s been getting lots of attention as the first truly new retinoid to reach the market in over twenty years. It received FDA approval in 2019 and since then got approval for use in the EU and UK. In this article we’ll cover what Aklief actually is, how it works and compare it against existing retinoids. We’ll also review how to access it in the UK and the alternatives.
What is Aklief?
Aklief is the brand name for trifarotene 0.005% cream which is made by Galderma. It’s a fourth-generation topical retinoid and is the same drug class as tretinoin and adapalene. However, it has a different mechanism of action at the skin cell level. The FDA approved it in October 2019 for treating acne in patients nine years and older, and the EMA followed in 2020 then the MHRA following that. It has approval for both facial and truncal acne, meaning back, chest and shoulders in patients aged 12 and upwards.
How Does Aklief Work?
All topical retinoids work by binding to retinoic acid receptors (RARs) in your skin cells. This then influences how those cells turn over, behaviour of follicles and regulation of inflammation. There are three subtypes of these receptors; RAR-alpha, RAR-beta and RAR-gamma. RAR-gamma is the one that’s most abundant in skin specifically.
Tretinoin binds all three receptor subtypes whilst adapalene binds RAR-beta and RAR-gamma. Trifarotene is the first retinoid to target RAR-gamma alone. The value of this is that, in theory, it should mean more activity in the skin and less systemic absorption when you apply it across larger body areas. This is the reason behind its licensing for back acne and chest acne where you’re covering a lot of surface area.
What Does the Evidence Show?
Trifarotene’s approval was on the basis of two large phase 3 trials called PERFECT-1 and PERFECT-2, published in the Journal of the American Academy of Dermatology in 2019. Together they studied over 2,400 patients with moderate facial and truncal acne. Patients got either trifarotene 0.005% cream once daily or a placebo cream for twelve weeks.
The key findings of these studies showed that trifarotene significantly reduced both inflammatory and non-inflammatory acne on the face. Trifarotene also had a similar effect on treating acne lesions on the chest and back. This is important as body acne is incredibly common but there are few clinical studies on treating it. No other prescription topical retinoid has had formal testing in this way for trunk acne. Despite these promising results, it’s worth pointing out that there are no clinical trials directly comparing trifarotene with prescription retinoids like tretinoin or adapalene.
Risks & Side Effects of Aklief
From the clinical data, it seems that Aklief is broadly safe. It’s side-effect profile is what you’d expect from any topical retinoid. The main possible risks or considerations include:
- Redness, scaling, dryness and stinging particularly during the first four to eight weeks.
- An initial purging period where existing acne may worsen before improving.
- Increased photosensitivity, which means daily SPF is non-negotiable whilst you’re using it.
- Trifarotene is not suitable for use whilst pregnant or trying to be.
- There may be more initial irritation when treating face and trunk together since you’re using more product across a larger area.
Application is broadly similar to most retinoids. A pea-sized amount is usually enough for the full face which you apply to dry skin in the evening. You may need to use a larger amount for the trunk depending on the size of the area that needs treating. New retinoid users typically start three nights a week and titrate up as the skin tolerates. Buffering with a layer of moisturiser before or after the retinoid is reasonable for sensitive skin.
How Does Aklief Compare With Other Retinoids?
Topical retinoids range from gentle over-the-counter (OTC) ingredients through to prescription medicines. Although they all work similarly, their intensity and overall all effects on the skin differs. Although there aren’t any clinical trials comparing Aklief with other retinoids directly, we can guess a bit from the available data:
- OTC retinoids: Retinol, retinaldehyde and retinyl esters are cosmetic-strength ingredients that you can buy without prescription. They act on the same receptors as Aklief but only after enzymes in your skin convert them into retinoic acid, which is why they’re gentler and less powerul. These are useful for maintenance and mild skin concerns. They are not strong enough for moderate, severe or persistent acne.
- Tretinoin: This is the most versatile and one of the longest studied topical retinoids. Tretinoin is a prescription retinoid with over sixty years of clinical use. It binds all three retinoic acid receptor subtypes and comes in multiple strengths and formulas. It can treat acne, hyperpigmentation, melasma, photoageing and post-acne scars. It’s also compatible with other actives like clindamycin, azelaic acid and hydroquinone and as such often used in custom compounded skin treatments.
- Adapalene: The closest retinoid to Aklief is probably adapalene (or Differin). This third generation retinoid selectively binds RAR-beta and RAR-gamma. It is less irritating than tretinoin and is a reasonable first-line option for mild-to-moderate acne. Adapalene is widely available by itself in two strengths as a gel or cream. Adapalene is also available in formulas containing benzoyl peroxide (Epiduo) or clindamycin (Duac).
- Tazarotene: Another third-generation retinoid, this binds RAR-beta and RAR-gamma. The FDA has given approval for tazarotene in both acne and psoriasis but it is not readily available in the UK. It’s the most irritating of the prescription retinoids and rarely a first or even second choice for acne.
- Isotretinoin: This is worth flagging as isotretinoin is an oral retinoid. This systemic treatment is effective for moderate-to-severe acne. It’s often not a first-line choice unless there is severe acne.
Is Aklief available in the UK?
Aklief cream is MHRA-approved in the UK for the topical treatment of acne vulgaris of the face and trunk in patients aged twelve and older. It’s a prescription-only medicine, so you can’t buy it over the counter. It also isn’t routinely prescribed on the NHS. Access in the UK is currently mainly through private prescription mainly via online pharmacies and private dermatology clinics.
What are the Alternatives to Aklief?
Acne is a multi-factorial condition and the right treatment varies from person to person. Aklief is an effective treatment for face and trunk acne but it is not appropriate for everyone. Below are some of the best known alternatives to Aklief:
- Tretinoin: This can be prescribed at a range of strengths in cream or gel form. It is also available alongside antibiotics or hydroquinone to tackle inflammatory acne and hyperpigmentation respectively.
- Adapalene: Available on the NHS and privately, adapalene is availble in a couple of strengths and in gel or cream formulas. It is often paired with benzoyl peroxide or antibiotics to treat moderate inflammatory acne.
- Azelaic acid: This is a non-retinoid alternative for treating mild acne that is available over the counter or by prescription. It can also help tackle skin texture and hyperpigmentation. Azelaic acid is particularly suitable for sensitive skin, rosacea and is also safe for use during pregnancy.
- Antibiotics: Oral or topical antibiotics like doxycycline, lymecycline or clindamycin can be useful for moderate inflammatory or body acne. They’re often useful alongside retinoids or azelaic acid.
- Hormone blockers: For women with hormonal acne, topical or oral spironolactone is sometimes used unlicensed to help reduce oil and breakouts. Winlevi, which has just been approved in the UK for acne, is another topical treatment that serves a similar function to spironolactone.
- Isotretinoin: For moderate-to-severe acne that hasn’t responded to topical and antibiotic options, isotretinoin remains the most effective treatment available.
Aklief is a meaningful addition to the topical acne armoury. It is particularly meaningful that the trials also supported safe and effective use for truncal acne. However, there are no head-to-head trials comparing it with pre-existing retinoids like tretinoin so it is difficult to gauge how it compares against these. Despite this, it’s still extremely helpful to have another option for acne as not everyone responds to the same treatments. If you’re experiencing severe or stubborn acne, it’s best to seek medical help. Your medical provider can then advise on the best treatment to safely tackle your specific skin concerns.
At City Skin Clinic, we don’t provide treatment with Aklief (trifarotene). We do however offer personalised acne treatments using ingredients like tretinoin, azelaic acid and spironolactone where appropriate tailored to suit your individual needs. Start a virtual consultation with one of our doctors and take your first step towards better skin.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
