Adapalene (0.3%)/benzoyl peroxide gel (2.5%) for adult female acne: a real-world case series from Latin America

Funding: Galderma Brasil Ltda funded medical writing assistance and the Article Publishing Charge.
Acknowledgments: To the patients who allowed us to publish their anonymized photos.
Conflict of interest: MAR received fees for classes and/or participation in advisory boards from Pierre-Fabre, FQM, Galderma, L'Oréal, Naos Group, Kenvue / J&J, Hypera, and Dove-Unilever. HAM received fees for classes and participation in advisory boards from Merz, Abbvie, Galderma, Kenvue, Pierre-Fabre, Pfizer, Eucerin / Beiersdorf, and L'Oréal. PT received fees for classes and/or participation in advisory boards from Galderma; L'Oréal, La Roche-Posay, and Eucerin / Beiersdorf. LF received fees for classes and/or participation in advisory boards from Galderma, Pierre-Fabre, Eucerin / Beiersdorf, NAOS / Bioderma, and ISDIN. AV is an employee of the Galderma Brazil Medical Affairs Department.
Submitted on: 03/25/2025
Final decision: 08/05/2025
How cite this article: Rocha MA, Fierro-Arias L, Troielli P, Viana A, Miot HA. Adapalene (0.3%)/benzoyl peroxide gel (2.5%) for adult female acne: a real-world case series from Latin America. Surg Cosmet Dermatol. 2025;17:e20250456.

To the Editor:

Adult female acne (AFA) is a common condition affecting women aged 25 years and older, with a chronic and relapsing course.¹ This multifactorial disorder is associated with hormonal imbalance (eg, polycystic ovary syndrome), psychological stress, genetics, and lifestyle factors, which collectively contribute to its complexity and challenging management.^1,2 The Latin American population has diverse characteristics, influenced by demographics, race/ethnicity, and exposome.³ In Brazil, the population prevalence of AFA has been estimated at 41%.⁴

Controlled trials of AFA treatment are scarce, but the primary therapeutic options typically include topical retinoids, antimicrobial agents, combined oral contraceptive pills, and spironolactone.^5-9

Early recognition and proper treatment of AFA are crucial to minimize complications such as scarring and hyperpigmentation as well as to reduce its impact on quality of life. Currently, the management of AFA must be tailored to individual characteristics, mitigating triggers and addressing key pathophysiologic mechanisms, including inflammation, comedogenesis, sebogenesis, and skin microbiome abnormalities.^2,9,10

In this retrospective case series, we present six cases of AFA from 3 Latin American countries (Brazil, Colombia, and Argentina) treated with a combination of adapalene 0.3%/benzoyl peroxide 2.5% gel (A0.3/BPO2.5) and other therapies. The primary reason for choosing these cases was to reflect the diversity in disease severity and the different treatment combinations applicable in real-world practice. These were consecutive cases treated in the authors' practice between August and September 2023, and all patients provided written informed consent for the publication of their photographs and clinical data. The study was approved by the institutional ethics committee (approval number 7.082.589).

Patient characteristics, treatments, and outcomes are presented in Table 1 and Figure 1.

In the first case, pronounced inflammation marked by pustules and nodules required a regimen of oral antibiotics associated with spironolactone and topical A0.3/BPO2.5. After four months of treatment, only minor erythema and residual acne scars were observed.

The second case presented primarily with papules and comedones. The patient was treated with A0.3/BPO2.5 for three months, resulting in a substantial decrease in lesions, though some scarring remained.

In the third case, papules, pustules, and skin pigmentation were evident. Following three months of treatment with oral spironolactone and A0.3/BPO2.5, there was an almost complete elimination of lesions, total resolution of pigmentation, and an improvement in overall skin quality.

After six months of treatment with a cyproterone acetate combined oral contraceptive and A0.3/BPO2.5, the fourth case experienced complete clearance of acne lesions and a substantial improvement in overall skin quality.

In the fifth case, inflammatory papules, comedones, and nodules showed total reduction following six months of treatment with oral spironolactone and A0.3/BPO2.5.

In the last case, mild papular AFA was successfully treated with a combination of oral spironolactone and A0.3/BPO2.5, resulting in a complete clearance within three months.

The multifactorial nature of AFA requires an approach encompassing an assessment of hormonal imbalance alongside management of inflammation, sebogenesis, and comedogenesis. Beyond cleansers, moisturizers, and photoprotection, the association of oral and topical therapies is a common practice, depending on the clinical presentation of the lesions and individual patient characteristics.^2,5

Topical combination of A0.3/BPO2.5 offers a synergistic strategy for treating acne. The comedolytic effect of adapalene, coupled with the antimicrobial, anti-inflammatory, and sebum-control properties of benzoyl peroxide, leads to superior performance compared to the use of either agent in isolation. In addition, adapalene reduces inflammation, making this combination appropriate for addressing various factors involved in the pathogenesis of different types of acne and skin phototypes.^9,11 A0.3/BPO2.5 is a well-tolerated topical treatment; nevertheless, its use every other day and/or in combination with the prior application of non-comedogenic moisturizers are alternatives for sensitive skin.

Antiandrogens (eg, spironolactone) are usually prescribed for AFA, even in cases where hormonal workups are normal, leading to a reduction in sebogenesis and consequent improvement in acne lesions. Contraceptive pills containing progestins with antiandrogenic properties (eg, cyproterone) are both effective in treating acne and in preventing relapse following remission.² Spironolactone can be used alone or together with combined oral contraceptive pills or intrauterine devices to achieve a synergistic effect, or in situations where counterbalancing the effects of levonorgestrel present in hormonal intrauterine devices is required.^9,12,13

Oral antibiotics, particularly tetracyclines, are recommended for moderate-to-severe inflammatory acne, typically for up to three months. Combining oral antibiotics with topical benzoyl peroxide minimizes the risk of inducing antimicrobial resistance.¹⁴ Oral isotretinoin is reserved for refractory AFA; nevertheless, prescribing with caution and providing reassurance is essential for women of reproductive age.¹⁵

The present cases emphasize the need to customize treatment plans and consider factors such as patient preferences, lifestyle, side effects, and contraindications (such as pregnancy or hyperkalemia).

In conclusion, this case series highlights the efficacy and tolerability of a combination approach in the treatment of adult female acne in real-world settings. The tailored use of A0.3/BPO2.5 alongside antiandrogens, combined oral contraceptive pills, and short courses of antibiotics highlights the need for individualized strategies to match disease severity and patient characteristics.

AUTHOR'S CONTRIBUTION:

Marco Alexandre Rocha
ORCID: 0000-0003-1090-177X
Approval of the final version of the manuscript; Conception and design of the study; Preparation and writing of the manuscript; Acquisition, analysis and interpretation of data; Effective participation in the conduct of the study; Intellectual participation in the propaedeutic and/or therapeutic approach to the cases studied; Critical review of the literature; Critical revision of the manuscript.
Leonel Fierro-Arias
ORCID: 0000-0001-6264-7342
Approval of the final version of the manuscript; Conception and design of the study; Preparation and writing of the manuscript; Acquisition, analysis and interpretation of data; Effective participation in the conduct of the study; Intellectual participation in the propaedeutic and/or therapeutic approach to the cases studied; Critical review of the literature; Critical revision of the manuscript.
Patricia Troielli
ORCID: 0000-0002-3070-3917
Approval of the final version of the manuscript; Conception and design of the study; Preparation and writing of the manuscript; Acquisition, analysis and interpretation of data; Effective participation in the conduct of the study; Intellectual participation in the propaedeutic and/or therapeutic approach to the cases studied; Critical review of the literature; Critical revision of the manuscript.
Anália Viana
ORCID: 0000-0002-1978-1367
Approval of the final version of the manuscript; Conception and design of the study; Preparation and writing of the manuscript; Acquisition, analysis and interpretation of data; Effective participation in the conduct of the study; Intellectual participation in the propaedeutic and/or therapeutic approach to the cases studied; Critical revision of the manuscript.
Hélio Amante Miot
ORCID: 0000-0002-2596-9294
Approval of the final version of the manuscript; Preparation and writing of the manuscript; Acquisition, analysis and interpretation of data; Intellectual participation in the propaedeutic and/or therapeutic approach to the cases studied; Critical review of the literature; Critical revision of the manuscript.

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