Trifarotene Administration in the Patient with Acne Conglobata and Autoimmune Hepatitis: Case Study

Background. Challenge in management of severe acne (conglobata, nodular) in patients with comorbid hepatopathy is associated to the high risk of systemic retinoids hepatotoxicity. Topical retinoid, trifarotene, as a selective RAR- (retinoic acid receptor) agonist, may be used as an alternative in these cases. Case description. Patient, 17 years old, with acne conglobata, facial and body skin lesions and comorbid autoimmune hepatitis type 1 (ANF-positive). Systemic isotretinoin administration along with immunosuppressive therapy (prednisolone, azathioprine) was considered unreasonable due to high risk of hepatotoxicity. Trifarotene cream (50 mcg/g) was prescribed once per day for 3 months with following switch to alternate days regimen. Complete regression of face, body and limbs rashes with no new eruptions was achieved after 3 months of external therapy. Moderate side effects (erythema, skin dryness and peeling) were noted on treatment, however, they were successfully relieved via dermatological cosmetics. It was recommended to continue trifarotene administration according to the alternate days regimen to maintain remission and to perform subsequently scar revision (laser, dermabrasion). Conclusion. High efficacy and safety of topical trifarotene has been noted in the patient with severe acne and comorbid autoimmune hepatitis, maintaining its remission (normal alanine aminotransferase, aspartate aminotransferase, bilirubin levels), and moderate side effects. This medication can be considered as an alternative to the systemic retinoid isotretinoin in patients with hepatopathy.

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