Acne vulgaris retinoids

Leyden JJ Topical treatment of acne vulgaris Retinoids and cutaneous irritation. J Am Acad Dermatol 1998 38 S1. 

When treating acne vulgaris, topical and systemic therapies (if indicated) are initiated 2 to 4 weeks prior to peeling. Topical antibiotics and benzoyl peroxide based products can be used daily and discontinued 1 or 2 days prior to peeling. However, unless a deeper peel is desired, retinoids should be discontinued 7-10 days prior to salicylic acid peeling. Broad-spectrum sunscreens (UVA and UVB) should be worn daily (see Photo damage. Sunscreen section). 

Liposome-encapsulated tretinoin has been tested in hairless mice as well as in man. The animal experiment has demonstrated the favorable uptake of the retinoid, whereas the liposomal lipids appear to be more retained in the homy layer [53], Moreover, with phospholipid-based liposomes belonging to the gel-state type, tretinoin penetration in murine skin appears to be confined to the epidermis [54] and, thus, is close to prednicarbate penetration described above. In patients with acne vulgaris, we could demonstrate a better tolerability of liposomal tretinoin as compared to a commercial gel while efficiency remains the same [55],... 

The past twenty years have witnessed considerable progress in the synthesis and use of other retinoid-like molecules related to vitamin A. The aromatic retinoid etretin (8.54) and its ester etretinate (8.55) had some effectiveness in the treatment of psoriasis, a disorder of skin. 13-cA-Retinoic acid (isotretinoin) produces sebaceous gland atrophy and could prove useful in the treatment of severe acne vulgaris. Although these compounds have toxic side effects and are not in regular use, they have opened up new therapeutic possibilities. Retinoic acid (tretinoin, 8.56) has been employed in the treatment of acne. 

Adapalene is a napthoic acid derivative with retinoid-like activity used for the topical treatment of acne vulgaris. Adverse effects include erythema, dryness of skin and skin irritation. 

Nyirady J, Grossman RM, Highland M, Berger RS, Jorizzo JL, Kim YH, Martin AG, Pandya AG, Schulz KK, Strauss JS. A comparative trial of two retinoids commonly used in the treatment of acne vulgaris. J Dermatolog Treat 2001 12(3) 149-57. 

Indications Acne vulgaris Category Retinoid Half-life N/A... 

Adverse effects of tetracyclines include resistant bacteria, folliculitis, candidiasis, gastrointestinal upset, and phototoxic effects. Tetracyclines must not be combined with systemic retinoids because of the increased probability for development of intracranial hypertension. Tetracycline is used in the treatment of moderate to severe acne vulgaris. It is the least expensive of the tetracyclines and therefore often prescribed for initial therapy. A common initial approach includes tetracycline 1 g daily (500 mg twice daily), 1 hour before meals after 1 or 2 months, when marked improvement of inflammatory lesions is observed, the dose may be decreased to 500 mg every day, for another 1 or 2 months. Drawbacks to the use of tetracycline include also a drug-food interaction with dairy prodncts. 

Bershad S, Pouhn YP, Berson, et al. Topical retinoids in the treatment of acne vulgaris. Cutis 1999 64 8-23. 

Tazarotene (Tazorac) is a third-generation retinoid approved for the treatment of psoriasis and acne vulgaris. This retinoid binds to aU three RARs. In mice, tazarotene blocks ornithine decarboxylase activity, which is associated with cell proliferation and hyperplasia. In cell culmre, it suppresses markers of epidermal inflammation and inhibits comification of the keratinocyte. 

Tazarotene (tazorac) is a third-generation retinoid approved for the treatment of psoriasis and acne vulgaris. This retinoid binds to all three RARs. 

Thielitz A, Gollnick H (2008) Topical retinoids in acne vulgaris update on efficacy and safety. Am J Clin Dermatol 9(6) 369-381... 

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