COMPARATIVE EFFICACY OF TOPICAL 0.1% ADAPALENE VERSUS TOPICAL 4% BENZOYL PEROXIDE IN THE TREATMENT OF COMEDONAL ACNE

Abstract

Background: Comedonal acne in the form of predominantly open and closed comedones is prevalent in adolescents and young adults and will become inflammatory acne if left untreated. Monotherapies in the form of topical treatment with adapalene (a third-generation retinoid) and benzoyl peroxide (BPO) are routine; yet direct comparison between them, particularly in South Asian population, is lacking.

Objective: To assess the efficacy, tolerability, and patient satisfaction of topical 0.1% adapalene compared to 4% benzoyl peroxide for treating comedonal acne over 12 weeks.

Methods: In this prospective, randomized, open-label trial conducted at CMH Abbottabad from April 2025 to September 2025, 226 patients aged 12–35 with ≥15 facial comedones were randomized in a 1:1 ratio between adapalene 0.1% gel and BPO 4% gel, applied nightly. Non-probability consecutive sampling was utilized. Baseline and weeks 4, 8, and 12 assessments included comedone count (primary outcome), Investigator Global Assessment (IGA), patient satisfaction (Likert scale), and local side effects. Data were examined with SPSS v26; t-tests (or Mann–Whitney U) and χ² (or Fisher's exact) tests were used, with p<0.05 as significance level.

Results: Both treatments decreased comedone counts by week 12 but with superior efficacy from adapalene: mean counts decreased to 14.8 ± 5.2 compared with 18.7 ± 6.1 in the BPO group (p<0.01). "Clear" or "almost clear" IGA scores at week 12 were obtained in 39.8% of the adapalene group versus 32.7% of the BPO group (p=0.04). High patient satisfaction was found in 72.6% with adapalene but only 66.4% with BPO (p=0.09). Local tolerability was in favor of adapalene with the incidence of erythema (19.4% vs. 25.7%), dryness (14.2% vs. 20.4%), and burning sensation (11.5% vs. 18.6%) being lower, though these differences were not statistically significant. There were no serious adverse events.

Conclusion: Topical 0.1% adapalene shows increased comedone reduction, similar patient satisfaction, and improved tolerability profile over 4% benzoyl peroxide, validating its use as first-line monotherapy for comedonal acne in identical clinical situations.