The Efficacy, Safety, and Tolerability of Adapalene Versus Benzoyl Peroxide in the Treatment of Mild Acne Vulgaris: A Randomized Trial

Topical treatments, such as adapalene and benzoyl peroxide (BPO), are popular in mild-to-moderate acne vulgaris. This study aimed to compare the efficacy, safety and tolerability of adapalene and BPO in mild acne vulgaris. In this single-center, randomized, double-blind, clinical trial, 60 patients with mild acne vulgaris received either topical adapalene 0.1% gel or topical BP 2.5% gel on their face once daily for two months. The changes of acne lesion count (efficacy), any adverse effect (safety), and the patients overall satisfaction (tolerability) were compared after 3 months of follow-up. In both groups the mean number of noninflammatory, inflammatory and total lesions decreased significantly from baseline (10.77 +/- 5.54, 9.73 +/- 5.09, and 20.50 +/- 7.54, respectively in adapalene group; 11.50 +/- 5.92, 8.43 +/- 5.45, and 19.93 +/- 9.01, respectively in BPO group) to the third month (1.70 +/- 1.68, 0.33 +/- 0.66, and 0.50 +/- 0.78, respectively in adapalene group; 4.23 +/- 4.14, 0.33 +/- 0.71, and 4.13 4.44, respectively in BPO group; P<0.001 for all), posttreatment. Although the mean number of inflammatory lesions was significantly lower in BP receivers only at first month (P =0.001), the mean number of noninflammatory and total lesions was significantly lower in adapalene group at second (P = 0.04 and 0.03, respectively) and third (P =0.02 and <0.001, respectively) months, posttreatment. The adverse events were minimal and self-limited (26.7% in adapalene group, 20% in BP0 group, p=0.541. The patients' overall satisfaction was good to excellent in 93.3% of adapalene receivers vs. 73.3% in BPO group (P=0.08). Both topical adapalene 0.1% and BP0 2.5% gels seem safe and effective in mild acne vulgaris, with a marginal tendency toward the former.