Pharmacy Author: Omudhome Ogbru, PharmD
Medical and Pharmacy Editor: Jay W. Marks, MD

GENERIC NAME: tretinoin

BRAND NAME: Retin-A, Atralin, Renova, Avita, Altinac

DRUG CLASS AND MECHANISM: Tretinoin is a derivative of vitamin A. Topical tretinoin is used 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, 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%, 0.1%. Cream: 0.02%, 0.025%, 0.05%, 0.1%.

STORAGE: Store between 15° and 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 is usually 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 distributed into breast milk. It is also unknown if topically applied tretinoin accumulates to an extent sufficient to pose a 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, 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 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.

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