***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Acne vulgaris is a multifactorial disorder which is ideally treated with combination therapy with topical retinoids and antibiotics . Objectives The present study was conducted to compare the efficacy and safety of tazarotene plus clindamycin against adapalene plus clindamycin in facial acne vulgaris . Methods This study is a r and omized , open-label , parallel design clinical trial conducted on 60 patients with facial acne at the outpatient dermatology department in a tertiary healthcare center . The main outcome measures were change in the acne lesion count , Investigator ’s Static Global Assessment ( ISGA ) score , Global Acne Grading System ( GAGS ) score , and Acne-Specific Quality of Life Question naire ( Acne-QoL ) at the end of 4 weeks of therapy . After r and omization one group ( n = 30 ) received tazarotene 0.1 % plus clindamycin 1 % gel and another group ( n = 30 ) received adapalene 0.1 % plus clindamycin 1 % gel for 1 month . At follow-up , all the parameter were reassessed . Result In both treatment regimens the total number of facial acne lesions decreased significantly . The difference in the change in the total count between the two combination regimens was also significant [ 6.51 , 95 % confidence interval ( CI ) 1.91–11.09 , p = 0.007 ] . A ≥50 % reduction in the total lesion count from the baseline levels was achieved by 71 % of patients in the tazarotene plus clindamycin group and 22 % of patients in the adapalene plus clindamycin group ( p = 0.0012 ) . The difference in the change of inflammatory ( p = 0.017 ) and non-inflammatory ( p = 0.039 ) lesion counts in the tazarotene plus clindamycin group were significantly higher than the adapalene plus clindamycin group . The difference in change of the GAGS score was also significantly higher in the tazarotene plus clindamycin group ( p = 0.003 ) . The ISGA score improved in 17 patients in the tazarotene plus clindamycin group versusnine patients in the adapalene plus clindamycin group ( p = 0.04 ) . The change of total quality -of-life score was found to be significantly ( p = 0.027 ) higher in the tazarotene plus clindamycin group . Conclusions Both treatment regimens were efficacious , but tazarotene plus clindamycin was found to be superior to adapalene plus clindamycin . The tolerability profile of both regimens was comparable . Trial Registration Clinical Trials.gov Identifier : BACKGROUND : Acne vulgaris affects a diverse group of people , and there is an increasingly wide variety of acne treatments . Because of the many options , clinicians have a better ability to individualize treatment ; however , achieving optimal results relies on underst and ing how various agents perform in specific population segments . Fixed-combination adapalene plus benzoyl peroxide ( A/BPO ) is a first-line recommended acne therapy and is available in two adapalene concentrations ( 0.1 % and 0.3 % ) combined with BPO 2.5 % . This analysis investigated whether gender and age have an impact on either the efficacy or safety of topical A/BPO 0.3 % . METHODS : A post-hoc sub analysis was performed on data from a multicenter , r and omized , double-blind , parallelgroup , 12-week study of A/BPO gel 0.3%/2.5 % or vehicle gel in subjects ≥ 12 years old with moderate to severe acne vulgaris ( Investigator global assessment [ IGA ] of 3 or 4 ) .  Efficacy measurements included achievement of an IGA of clear ( 0 ) or almost clear ( 1 ) , and change in lesion counts from baseline to week 12 . Safety measures included adverse events and cutaneous tolerability . The intent to treat ( ITT ) and safety population s were analyzed . RESULTS : The A/BPO gel 0.3%/2.5 % treatment group included 217 subjects . Among the subjects , 111 were 12 - 17 years old and 106 were ≥ 18 years old ; 104 were male and 113 were female .  A/BPO 0.3%/2.5 % was safe , tolerable , and significantly superior to vehicle in success rates ( IGA 0 or 1 ) and reduction of inflammatory/noninflammatory lesions ( P≤0.05 ) across both age groups and genders . CONCLUSIONS : A/BPO 0.3%/2.5 % treatment achieved success and was equally effective and safe in younger vs older subjects and in males vs females . These results support the use of A/BPO 0.3%/2.5 % in all subjects 12 and older . Clinical trials.gov registry : ( NCT01880320 ) J Drugs Dermatol . 2017;16(6):582 - 589 Treatment of acne vulgaris can be challenging for both patients and physicians . Topical retinoids are often considered first-line therapy for the treatment of all but the most severe forms of acne . A variety of formulations of topical retinoids , including adapalene and tazarotene , are available but tazarotene 0.1 % gel is widely perceived to be the most efficacious . The goal of this study was to evaluate the efficacy and tolerability of a new , higher concentration of adapalene , adapalene 0.3 % gel , compared to tazarotene 0.1 % gel in the treatment of acne vulgaris . The primary efficacy outcome was the percent reduction in total lesion count at week 12 . Subjects 12 to 35 years of age with acne vulgaris ( N=172 ) participated in a 12-week , r and omized , evaluator-blinded , noninferiority study of once-daily therapy with adapalene 0.3 % gel or tazarotene 0.1 % gel . Subjects in each group achieved clinical ly significant reductions in total lesion counts at week 12 ( 61 % and 57 % median reductions for adapalene and tazarotene , respectively ) ; adapalene 0.3 % gel was noninferior to tazarotene 0.1 % gel ( 95 % confidence interval [ CI ] : -5.2 - 9.6 ) . The adapalene arm was also therapeutically similar to the tazarotene arm in terms of the percent reduction in inflammatory and noninflammatory lesion counts at week 12 , as well as in the assessment s of acne severity and improvement . Mean tolerability scores for erythema , dryness , scaling , and stinging/burning were consistently lower in the adapalene arm compared to patients treated with tazarotene ( P<.014 at week 12 , Cochran-Mantel-Haenszel [ CMH ] test ) . The worst score for any tolerability parameter in the treatment phase in the adapalene arm was less than 1 ( mild ) . Adapalene was also associated with a lower incidence of treatment-related adverse events when compared to tazarotene ( 3.5 % versus 14 % , respectively ) . Once daily therapy with adapalene 0.3 % gel provided similar efficacy ( noninferior ) to tazarotene 0.1 % gel in the treatment of acne vulgaris , but demonstrated a superior tolerability profile A r and omized , multicenter , investigator-blinded , active- and vehicle-controlled study was conducted to evaluate the efficacy and safety of adapalene gel 0.3 % versus adapalene gel 0.1 % and the corresponding gel vehicle . Subjects were assigned r and omly to receive either adapalene gel 0.3 % , adapalene gel 0.1 % , or vehicle once daily for 12 weeks . A total of 214 subjects with moderate to moderately severe acne vulgaris were enrolled , and 85 % of subjects completed the study .  Adapalene gel 0.3 % was significantly superior to adapalene gel 0.1 % in total and noninflammatory lesion counts and in global severity score ( P < .05 for all ) . A concentration-dependent increase in clinical benefit for all efficacy assessment s was observed . As expected , there were also statistically significant differences in all efficacy parameters in the adapalene gel 0.3 % group relative to the vehicle group ( P < .001 for all ) . Treatment-related adverse events were mostly mild-to-moderate and similar between active groups . The results of this study show that adapalene gel 0.3 % was superior to adapalene gel 0.1 % and vehicle in the treatment of moderate to moderately severe acne while retaining a similar safety and tolerability profile to adapalene 0.1 % gel BACKGROUND Moderate to severe acne vulgaris is often treated with a combination of an oral antibiotic , topical antibiotic/retinoid , and benzoyl peroxide ( BP ) , but data are limited on the efficacy of this and other combination regimens that incorporate both oral and topical therapies . METHODS Patients were required to be aged 12 - 30 years with moderate to severe acne ( grade s 3 - 4 acne on the Investigator 's Global Assessment [ IGA ] ) and deemed potential c and i date s for treatment with isotretinoin .  Enrolled patients were given triple-combination therapy , defined in this study as oral minocycline HCl extended release 1 mg/kg QD , 6 % BP foaming cloths used QD , and clindamycin phosphate 1.2%/tretinoin 0.025 % gel applied QD , and were evaluated at baseline and weeks 2 , 4 , 8 , and 12 . RESULTS A total of 97 patients were enrolled in the study . At week 12 , 89 % of patients had at least a one- grade improvement from baseline IGA and 96 % had at least a one- grade improvement from baseline Global Aesthetic Improvement Scale score . Mean ± SD in- flammatory , non-inflammatory , and total lesion counts decreased from baseline by 61.8 % ± 38.3 % , 48.8 % ± 34.5 % , and 56.5 % ± 29.9 % , respectively . The percentage of patients evaluated as c and i date s for isotretinoin by independent photographic review was 77 % ( 69/90 ) at baseline and only 16 % ( 14/90 ) at week 12 . Treatment-related adverse events ( AEs ) occurred in eight of 97 ( 8 % ) patients . Triplecombination therapy was not associated with any serious AEs or AEs leading to discontinuation . CONCLUSION Triple-combination therapy was well tolerated and substantially reduced facial acne lesion counts , with 84 % of patients judged to no longer be c and i date s for isotretinoin therapy by study end . These data support the clinical observation that a triple-combination regimen incorporating oral minocycline ( dosed by patient weight ) , BP foaming cloths 6 % QD , and clindamycin phosphate 1.2%/ tretinoin 0.025 % gel QD can substantially improve moderate to severe acne vulgaris There is a paucity of treatment options for severe acne vulgaris aside from oral isotretinoin . This r and omized , vehicle-controlled , multicenter , double-blind study evaluated the efficacy and safety of combination therapy using adapalene 0.1%-benzoyl peroxide 2.5 % ( A/BPO ) fixed-dose combination gel with doxycycline hyclate 100 mg in the treatment of severe acne vulgaris . A total of 459 participants were r and omized in a 1:1 ratio to receive oral doxycycline hyclate 100 mg once daily and either A/BPO or vehicle once daily for 12 weeks . Efficacy in the A/BPO with doxycycline group was demonstrated as early as week 2 compared with the vehicle arm for total , inflammatory , and noninflammatory lesions ( all P < .005 ) . At week 12 , this combination was superior to vehicle with doxycycline in reducing total , inflammatory , and noninflammatory lesion counts ( an added incremental benefit of 23 % , 24 % , and 21 % , respectively ) , as well as for global success and overall participant satisfaction ( all P < .001 ) . Digital UV fluorescence photography demonstrated a rapid reduction in Propionibacterium acnes in the A/BPO with doxycycline group , particularly within the first 4 weeks . These findings provide evidence on the efficacy of combining A/BPO and the oral antibiotic doxycycline in the treatment of severe acne vulgaris BACKGROUND Topical combination therapy containing a retinoid and an antimicrobial is an effective treatment for acne vulgaris . OBJECTIVE To evaluate the efficacy and safety of a new topical formulation containing clindamycin phosphate 1.2 % and tretinoin 0.025 % solubilized in an aqueous-based gel ( CT gel ) . METHODS 1,649 participants were r and omized 2:2:2:1 to 12 weeks of double-blind treatment with CT gel , clindamycin , tretinoin , or vehicle gel administered once daily . RESULTS Significantly more participants achieved 2- grade or greater improvement on the Investigator 's Static Global Assessment score with CT gel versus clindamycin , tretinoin 
    Output:
    
Conclusions Topical retinoids are safe and efficacious for the treatment of acne vulgaris .
The differences in efficacy of topical retinoids appears minor ; therefore , the type of topical retinoid is not as important as choosing a particular strength of topical retinoid and combining it with an antimicrobial agent .
Adapalene has a superior tolerability profile amongst topical retinoids