Trifarotene

Tolerability and safety

Irritation potential

Medium

Allergen risk

Low

Pregnancy

Avoid

Use with caution

Sensitive

About this ingredient

Trifarotene is a fourth-generation retinoid with selective activity at the RAR-γ receptor. Galderma launched it in 2019 as Aklief (50 µg/g cream). The FDA approved it for facial and truncal acne in patients aged 9+, the EMA followed in 2020. In Spain it is prescription-only. Mechanism. RAR-γ is the main retinoid receptor in skin (90% of all skin RAR). Selective binding means fewer systemic side effects (RAR-α and β work in liver and mucosa). Normalises follicular keratinisation, resolves comedones, suppresses inflammation and post-acne pigmentation. Where applied. Aklief 50 µg/g is the only registered form (cream for face and body). Apply once daily in the evening as a thin layer on clean, dry skin. Course 12-24 weeks, then maintenance 2-3 times weekly long-term. Evidence base. Two pivotal RCTs (PERFECT 1 and 2, Tan 2019) in 2400 patients over 12 weeks showed 60-70% reduction in inflammatory and non-inflammatory acne lesions and improvement of post-acne pigmentation on the trunk – unique among topical retinoids. Efficacy comparable to adapalene 0.3% with slightly better tolerability. Safety. Local irritation (burning, erythema, peeling) in 20-30% of patients during the first 2-4 weeks – less than tretinoin and adapalene 0.3%. Does not directly photosensitise, but SPF 50 is mandatory because of thin skin during treatment. Pregnancy and lactation – contraindicated. Despite low systemic absorption (<2%), all retinoids as a class carry a theoretical teratogenic risk. AEMPS and EMA recommend stopping at least 1 month before conception and avoiding use throughout pregnancy and lactation. Suited for. Inflammatory and comedonal acne of face and trunk (shoulders, chest, back), post-acne pigmentation in patients with phototypes III-V. Advantage over other retinoids – approved for large body areas.

Frequently asked questions