Adapalene/Benzoyl Peroxide Versus Retinoid Monotherapy for Acne Maintenance: Evidence, Relapse Prevention, And Practical Selection

Abstract

Acne vulgaris is a chronic relapsing inflammatory disease that frequently requires maintenance therapy after initial clinical improvement. Topical retinoids are widely considered the foundation of acne maintenance because they prevent microcomedone formation, normalize follicular keratinization, and reduce new lesion development. Benzoyl peroxide provides complementary antimicrobial and anti-inflammatory effects without inducing bacterial resistance. Fixed-dose adapalene/benzoyl peroxide combines these mechanisms and may offer superior relapse prevention compared with retinoid monotherapy, particularly in patients with moderate-to-severe, inflammatory, relapse-prone, or post-isotretinoin acne. Maintenance-specific evidence shows that adapalene/benzoyl peroxide reduces relapse and prolongs remission compared with vehicle, while active-treatment trials consistently demonstrate greater efficacy of the combination compared with adapalene alone. However, direct head-to-head trials comparing adapalene/benzoyl peroxide with retinoid monotherapy specifically during the maintenance phase remain limited. Therefore, current evidence supports adapalene/benzoyl peroxide as a strong maintenance option, especially in higher-risk patients, while retinoid monotherapy remains appropriate for milder, comedonal, or irritation-prone acne. This review summarizes the comparative evidence, mechanistic rationale, tolerability profile, and practical clinical selection of adapalene/benzoyl peroxide versus retinoid monotherapy in acne maintenance.