Aklief | A cream that tackles both the skin barrier and sebum

Aklief is a topical retinoid used to treat acne.

For dermatitis patients with acne, it is prescribed not only to treat acne but also to make it possible to use richer moisturizers.

1. What is Aklief?

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Aklief is a 4th-generation retinoid ointment that follows Stieva-A and T&T Cream (1st generation) and Differin (3rd generation). Its active ingredient is trifarotene (Trifarotene), which selectively binds to the RAR-γ receptor, the most widely distributed in the skin.¹

Retinoids are medications that inhibit excessive keratin and sebum from clogging pores. They have also been reported to strengthen the skin barrier with long-term use.²

2. Why Aklief is used for dermatitis patients

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The core of atopic dermatitis, rosacea dermatitis, and seborrheic dermatitis is skin barrier damage. When the barrier is weak, the skin is vulnerable to external irritation, so protecting the skin with a rich cream is the foundation of treatment.

However, rich moisturizers can clog pores and worsen acne, and this medication can be a solution. In addition, with long-term use, it helps strengthen the skin barrier.

Oral retinoids can have similar effects, but they may cause side effects such as dryness of the lips and eyes throughout the body, so for long-term use, topical retinoids are more suitable.²

3. How acne develops

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Acne occurs when keratin and sebum clog pores, and Aklief suppresses excessive keratin and sebum production (for details, see the Acne page).

Therefore, even while using rich moisturizers, it can help reduce acne worsening due to clogged pores. Whether it is needed is determined by assessing the degree of pore blockage with a Wood’s lamp exam.

4. Less irritating than previous generations

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Retinoids extend the lifespan of keratinocytes. As cells live longer, there are fewer dead cells to make up the stratum corneum, and the adhesion between dead cells also weakens.³ As a result, the skin barrier may weaken early in use.

However, in our experience, Aklief tends to cause less of this irritation than previous-generation retinoids. This is presumed to be because earlier retinoids stimulate RAR-α · β · γ simultaneously, whereas this medication selectively binds only to RAR-γ.⁴

5. Why oral retinoids are used first

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In many cases, using an oral retinoid first and then Aklief is more effective than starting Aklief right away.

This is thought to be because using an oral retinoid to open the pores allows the medication to reach deeper inside the pores more effectively.

You can learn more about oral retinoids on the Isotynoin page.

6. How to use

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Even though it is less irritating than previous generations, Aklief is still a retinoid, so you should start conservatively.

1. Mix an amount of Aklief about half a fingernail with a moisturizer, then spread a thin layer over the entire face, avoiding the eye area. If you do not mix it with a moisturizer, you should start with an amount so small that you would not be able to apply it to the entire face.
2. For the first 2 weeks, apply it only once every 3 days and check your skin’s response.
3. If your skin becomes red after use or dermatitis flares up again, reduce the amount and frequency, or stop completely if needed. Conversely, if there are no side effects, gradually increase the amount or frequency.

7. Pregnancy · breastfeeding

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Because Aklief is a retinoid medication, it cannot be used during pregnancy. Systemic absorption is very low with topical application, but it is still contraindicated during pregnancy. If you learn you are pregnant while using it, you must stop immediately.

Caution is also needed while breastfeeding. It has not been confirmed whether a topically applied medication transfers into breast milk. If use is necessary while breastfeeding, use it for a short period on the smallest area possible, and do not apply it to the nipple or areola.

8. Conclusion

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For dermatitis patients, rich moisturizers are very helpful for protecting the barrier, but they can clog pores and trigger acne. Aklief can help resolve this dilemma by preventing pore blockage while also strengthening the skin barrier over the long term.

If your pores are significantly clogged, it may be effective to start after first clearing the pores with Isotynoin.

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References

1. Thoreau E, Arellano C, Jourdan F, et al. Structure-based design of Trifarotene (CD5789), a potent and selective RARγ agonist for the treatment of acne. Bioorg Med Chem Lett. 2018;28(10):1736-1741.
2. Aubert J, Piwnica D, Bertino B, et al. Nonclinical and human pharmacology of the potent and selective topical retinoic acid receptor-γ agonist trifarotene. Br J Dermatol. 2018;179(2):442-456.
3. Yoon J, Bhatt LR, Yoo HJ, et al. Retinoid Induces the Degradation of Corneodesmosomes and Downregulation of Corneodesmosomal Cadherins: Implications on the Mechanism of Retinoid-induced Desquamation. Korean J Invest Dermatol. 2011;18(3):112-118.
4. Sadeghian A, Markowski T, Engstrom KG, et al. Assessing the Safety and Efficacy of Trifarotene in the Treatment of Acne Vulgaris. Ther Clin Risk Manag. 2021;17:741-756.