General

Pronunciation:
a-dap-a-leen

Trade Name(s)

• Differin

Ther. Class.
antiacne agents

Pharm. Class.
retinoids

Indications

Management of acne vulgaris.

Action

Binds to retinoic acid nuclear receptors resulting in decreased microcomedone formation.

Therapeutic Effect(s):

Reduction in inflammatory and non-inflammatory acne lesions.

Pharmacokinetics

Absorption: Minimal systemic absorption occurs with limited surface-area application.

Distribution: Unknown.

Metabolism and Excretion: Excreted via the biliary route.

Half-life: Unknown.

TIME/ACTION PROFILE (improved skin appearance)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity.

Use Cautiously in:

• OB:   Use during pregnancy only if potential benefit justifies the potential risk to the fetus
• Lactation: Safety not established;
• Pedi:  Children <12 yr (safety and effectiveness not established).

Adverse Reactions/Side Effects

Derm: burning, dryness, erythema, pruritus, scaling, photosensitivity

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

• Concurrent use with  keratolytic agents  (benzoyl peroxide, salicylic acid, sulfur, or resorcinol) ↑ risk of excessive skin irritation.
• ↑ risk of photosensitivity with other  photosensitizing agents .
• Risk of irritation ↑ by other  topical skin-care products  (aftershave, cover-up, make-up, perfumes, colognes).

Route/Dosage

Topical  (Adults and Children)  ≥12 yr) Apply once daily at bedtime.

Availability (generic available)

Cream: 0.1%

Gel: 0.3% ^OTC

Lotion: 0.1%

Assessment

• Assess skin prior to and periodically during therapy. Transient worsening of acne may occur at initiation of therapy. Note degree of skin dryness, erythema, and itching. Usually occur during first 2–4 wks of therapy. May need to reduce frequency or discontinue therapy.

Potential Diagnoses

• Risk for impaired skin integrity (Indications)  (Side Effects) 
• Disturbed body image (Indications) 

Implementation

• Topical  Cleanse area with mild or soapless cleanser before applying medication. Apply thin film of cream to areas where acne lesions appear, once daily at nighttime. A mild transitory sensation of warmth or slight stinging may occur shortly after application. Avoid contact with the eyes, lips, angles of the nose, and mucous membranes. Do not apply to cuts, abrasions, eczematous or sunburned skin. May use moisturizers but avoid products containing alpha hydroxy or glycolic acid. Avoid waxing skin in treated area.

Patient/Family Teaching

• Instruct patient on correct technique for application of cream.
• Explain to patient that a temporary worsening of acne may occur at beginning of therapy.
• Caution patient to use sunscreen and protective clothing to prevent photosensitivity reactions. Health care professional should be consulted about sunscreen, as some sunscreens may worsen acne.
• Advise female patients to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Evaluation/Desired Outcomes

Reduction in inflammatory and non-inflammatory acne lesions.