Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Tretinoin is a derivative of vitamin A. It
is used on the skin (topically) in the treatment of
mild to moderate acne and on
skin that has been damaged by excessive exposure to the sun. Tretinoin irritates
the skin and causes the cells of the skin to grow (divide) and die more rapidly,
increasing the turnover of cells. The number of layers of cells in the skin
actually is reduced. In patients with acne, new cells replace the cells of
existing pimples, and the rapid turnover of cells prevents new pimples from
forming. By a similar mechanism, tretinoin can reduce some wrinkles, areas of
darkened skin (hyperpigmentation), and rough areas of skin, all of which occur
in sun-damaged skin. In patients with sun-damaged skin, improvements in the skin
usually are seen within the first 3 to 4 weeks of treatment. Brown spots begin
to fade after six to eight weeks. Wrinkles decrease or disappear after three to
six months. Following application to the skin, a minimal amount of drug is
absorbed into the body. The FDA approved topical tretinoin in 1971.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Gel: 0.01%, 0.025%, 0.04%, 0.05%, and 0.1%. Cream:
0.02%, 0.025%, 0.0375%, 0.05%, and 0.1%. Solution: 0.05%. Capsule: 10 mg.
STORAGE: Tretinoin should be store at room temperature, between 15-25
C (59 -77 F).
PRESCRIBED FOR: Topical tretinoin is used for treating mild to
moderate acne, fine wrinkles and hyperpigmentation.
DOSING: Before applying
topical tretinoin, the affected area of the skin should be cleansed with soap
and dried. Patients should then wait 20 to 30 minutes before applying tretinoin,
gently rubbing it into the affected area. The hands should be washed immediately
after application. Tretinoin usually is applied once daily, in the evening.
DRUG INTERACTIONS: Combining other topical acne medications (for
example, salicylic acid) with tretinoin may lead to excessive skin irritation.
Use of abrasive soaps or cleansers, astringents, skin waxes and other products
that irritate the skin may add to tretinoin-induced skin irritation. Medications
[for example, tetracycline (Achromycin)] that cause sun sensitivity should not
be combined with tretinoin because of additive
sun sensitivity.
PREGNANCY: There are no adequate studies of topical tretinoin use
during pregnancy. Physicians must weigh the potential risks and benefits before
prescribing tretinoin during pregnancy.
NURSING MOTHERS: It is unknown whether tretinoin is secreted into
breast milk. It also is unknown if topically applied tretinoin accumulates to an
extent sufficient to be of concern in the infant. Nonetheless, since oral
tretinoin is not recommended during lactation, it probably is prudent to avoid
nursing during treatment with topical tretinoin.
SIDE EFFECTS: Following the application of tretinoin to the skin,
there often is local inflammation. This reaction disappears when treatment is
stopped. Mild stinging or a sensation of warmth also can occur when applying
tretinoin. Dryness, scaling, itching, and redness occur frequently. If severe
redness, vesicles or crusting develops, a physician should be notified
immediately and tretinoin stopped. It may be possible to restart therapy with a
lower concentration. Some patients may experience an initial flare up of acne.
Some patients using tretinoin develop increased sun sensitivity and are more
prone to sunburn (photosensitivity). Therefore, it is advisable to avoid
exposing treated areas of the skin to excessive sunlight or UV lamps to reduce
the risk of severe sunburn.
Acne is a localized skin inflammation as a result of overactivity of oil glands at the
base of hair follicles. This inflammation, depending on its location, can take the form
of a superficial pustule (contains pus), a pimple, a deeper cyst, congested pores, whiteheads, or blackheads. Treatments vary depending on the severity of the acne.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Ingrown hairs may be caused by improper shaving, waxing or blockage of the hair follicle. Symptoms and signs of ingrown hairs include itching, tenderness, and small red pus bumps. Ingrown hairs usually heal on their own, but topical antibiotics, chemical depilatories, and hair-removal laser may be used in the treatment of ingrown hairs.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Stretch marks occur in the dermis, the elastic middle layer of skin that allows it to retain its shape. When the skin is constantly stretched, the dermis can break down, leaving behind stretch marks.
Molluscum contagiosum is a skin infection caused by the poxvirus. Molluscum contagiosum appears as small tan or pink bumps on any part of the skin. Symptoms include a red or flushed appearance of the infected skin. Treatment may involve cryotherapy, manual extraction, surgical removal, the use of Retin-A, or the application of chemical acid.
Melasma is a patchy brown discoloration of the skin on the face. When it occurs in pregnancy, it's called chloasma. Melasma is commonly treated with hydroquinone creams.
Sun sensitivity (photosensitivity) is an inflammation of the skin induced by the combination of medications or substances and sunlight. The affect on the skin is redness, which looks similar to a sunburn. Generally, these reactions are either phototoxic or photoallergic. Phototoxic drugs are more common than photoallergic drugs. Symptoms of phototoxic reactions are a burning and stinging sensation and then redness. Symptoms of photoallergic reactions are itching, redness, swelling, blisters of the affected area. Treatment generally is discontinuation of the medication and topical application of creams.
Sunburn is caused by overexposure to UV radiation from the sun. UV rays can also damage the eyes. Repeated overexposure to UV rays also increases the risk for scarring, freckles, wrinkles, and dry skin. Symptoms of sunburn include painful, red, tender, and hot skin. The skin may blister, swell, and peel. Sun poisoning (severe sunburn) include nausea, fever, chills, rapid pulse, dizziness and more. Treatment for sunburn depends upon the severity. Sun protection and sunscreen for an individual's skin type is recommended to decrease the chance of sunburn.
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.
Sunscreens are crucial for sun protection. Sun damage to the skin from exposure to ultraviolet rays is a risk factor for skin cancer and melanoma. To avoid sunburn, people should limit sun exposure during the peak hours of 10 a.m. to 3 p.m., wear protective clothing, and use a sunscreen. People with sensitive skin should use a sunscreen with an SPF of 30 or more.
Sunburn is an inflammation of the skin that is caused by overexposure to
ultraviolet (UV) radiation from the sun. A similar burn can follow overexposure
to a "sun" (UV or tanning) lamp. UV radiation can also damage the eyes, although no
surface burn is apparent.
Sunburn is a very common condition. In the United States, approximately 30%
to 40% of adults and close to 80% of children and adolescents report having at
least one sunburn in the preceding year.
Can sunburn cause permanent damage?
Yes. Sunburn early in life increases the risk of developing skin cancer later
on. Repeated overexposure to ultraviolet rays can also
scar,
freckle, dry out,
and wrinkle the skin prematurely. In addition, frequent overexposure to
ultraviolet rays can increase the risk of developing eye cataracts and
macular
degeneration, a leading cause of blindness.
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