Expert Panel Provides Clinical Guidance for the Use of Trifarotene in Malaysian Acne Care

Trifarotene, a fourth-generation topical retinoid with selective retinoic acid receptor-γ (RAR-γ) activity, has demonstrated efficacy for both facial and truncal acne, yet its role was only briefly addressed in Malaysia’s 2022 Clinical Practice Guidelines (CPGs) due to its unavailability at the time.¹ An expert advisory paper sought to bridge that gap by synthesizing current evidence and expert consensus to provide practical guidance on incorporating trifarotene into routine acne care in Malaysia.²

Methodology and Expert Consensus

A targeted literature review was conducted from May to August to evaluate trifarotene’s efficacy, safety, pharmacokinetics, and clinical positioning, with particular emphasis on truncal acne and acne-related sequelae such as hyperpigmentation and atrophic scarring. This evidence from PubMed, Cochrane Library, and Google Scholar databases was reviewed by a panel of 10 Malaysian dermatologists representing public, private, and academic practice. Using structured surveys and consensus meetings, the panel developed and unanimously endorsed 10 advisory statements. Additionally, 3 illustrative case studies were included to demonstrate real-world application across varying acne severities and patient profiles.

Clinical Positioning and Efficacy of Trifarotene

The advisory panel positioned trifarotene alongside established first-line topical agents for mild-to-moderate facial and truncal acne. The panel presented clinical trials, including the PERFECT, DUAL, START, and LEAP studies, that consistently demonstrated significant reductions in inflammatory and non-inflammatory lesions on both the face and trunk, with sustained efficacy up to 52 weeks.

Beyond lesion clearance, emerging evidence supports trifarotene’s role in improving acne-induced hyperpigmentation and atrophic scarring. These outcomes are of particular relevance in Asian populations and patients with darker skin phototypes. Improvements in scarring were observed as early as 2 weeks in clinical trials, while reductions in post-acne hyperpigmentation were documented by weeks 12 to 24. The panel emphasized that these benefits occur in the context of active acne treatment rather than as a standalone therapy for established scars.

Patient Selection, Dosing, and Combination Therapy

Patient selection recommendations focused on adolescents aged ≥12 years and adults with mild to moderate disease, including those at higher risk for hyperpigmentation or scarring. Trifarotene was not recommended as monotherapy for nodulocystic acne, which typically requires systemic therapy. Combination regimens, particularly with oral antibiotics, were also endorsed. Furthermore, the panel addressed combination use with other topical agents such as benzoyl peroxide or azelaic acid, recommending staggered application schedules to minimize irritation and preserve stability.

Practical guidance on dosing and tolerability was a central component of the advisory. Trifarotene should be applied once nightly to clean, dry skin, extending beyond visible lesions, with a minimum treatment duration of 12 weeks. Incremental initiation strategies, including alternate-day or brief-contact application, were strongly recommended to mitigate early retinoid dermatitis. The panel endorsed the “Cleanse–Treat–Moisturize–Photoprotect” regimen as a foundational approach to improve tolerability and adherence. Clinical trial data indicate that local irritation typically peaks in the first 1 to 4 weeks and diminishes with continued treatment.

Special populations were also addressed in these advisory statements. Trifarotene demonstrated favorable safety and efficacy in adolescents, while its use during pregnancy and lactation remains contraindicated due to limited safety data. The panel highlighted the importance of tailored initiation strategies for patients with sensitive skin or those prone to post-inflammatory hyperpigmentation.

Conclusion

Overall, this expert advisory paper provides timely, evidence-based guidance on the integration of trifarotene into acne management in Malaysia, particularly in areas insufficiently addressed by current Clinical Practice Guidelines. As additional real-world and comparative data emerge, the panel predicts that trifarotene is likely to assume an increasingly important role in comprehensive acne care, especially for truncal disease and acne-induced sequelae.

References

1. Clinical Practice Guidelines: Management of Acne Vulgaris, 2nd ed. Ministry of Health Malaysia, 2022.

2. Mohd Affandi A, Ch'ng PWB, Teoh BTY, et al. Bridging Gaps in Malaysian Acne Vulgaris Guidelines: Advisory Statements on Trifarotene for Facial and Truncal Acne. J Cosmet Dermatol. 2026;25(1):e70625. doi:10.1111/jocd.70625