Retinoid dermatitis

In general, retinoids are also well tolerated in darker skin types however, retinoid dermatitis may cause post-inflammatory hyperpigmentation. In addition, progressive hyperpigmenta-... 

Exclude viral or bacterial infections and inflammatory dermatosis including retinoid dermatitis and skin irritation (shaving, use of facial scrubs) in the area that should be treated. 

High daily doses of retinoids can lead to hyper-vitaminosis A manifesting itself as dermal toxicity such as erythematous dermatitis, bone pains, neurological symptoms and hepatosplenomegaly. A recent study shows a correlation between low bone mineral density and too high intake of vitamin A. 

Patients should be warned of the high probability of adverse effects, which fortunately are only temporary. Tretinoin is more irritant than glycolic acid. The irritation is usually mild, but can take the form of retinoid dermatitis if high concentrations are used or if the skin is delicate. 

Adverse reactions to tretinoin—snch as skin irritation, erythema, and peeling—will vary depending on individual skin type and dosage form used. AUergic contact dermatitis is rare and much less common than with BPO. Teratogenicity risk with topical retinoids remains controversial. 

Li M, Messaddeq N, Teletin M, Pasquali JL, Metzger D, Chambon P Retinoid X receptor ablation in adult mouse keratinocytes generates an atopic dermatitis triggered by thymic stromal lymphopoietic Proc Natl Acad Sci USA 2005 102 14795-14800. 

Kojic acid (5-hydroxy-4 pyran 4-1-2 methyl) is a fungal derivative which inactivates tyrosinase via chelation of copper. Concentrations range from 2% to 4%. It can be used for monotherapy or in combination with retinoids or other cosmeceutical products such as glycolic acid. Compared to hydroquinone, these kojic acid formulations usually show less efficacy however, they may be effective in patients who do not tolerate hydroquinone. In addition, they can be used as maintenance therapies for treatment of hyperpigmentation following 4-6 months of hydroquinone treatment. Use of kojic acid has been associated with contact dermatitis in sensitized individuals, however [41 3]. 

Active infections or open wonnds Active retinoid dermatitis Cardiac disease Continned UV light exposure Fitzpatrick skin types IV to VI Hepatic disease Herpes simplex infection History of certain skin diseases (i.e., rosacea, seborrheic dermatitis, atopic dermatitis, psoriasis, vitiligo)... 

The frequency and severity of adverse reactions are also specific for the various retinoids (Table IX). For example, cheilitis, facial dermatitis, and conjunctivitis are frequently occurring side effects of isotretinoin therapy whereas telogen effluvium, palmar-plantar desquamation, skin fragility, paronychia, arthralgias, and pruritus are more commonly observed in patients receiving etretinate. 

Topical isotretinoin, 0.2% in a vanishing cream base and applied twice daily for 20 weeks, led to decreased lesion counts, no cutaneous irritation, and a 30% decrease in skin surface lipids in 20 patients with acne (Plewig et al., 1983). Topical administration of the retinoidal benzoic acid derivative TTNPB ethyl ester (G6) was toxic to hamsters in concentrations of 0.(X)l-0.3% causing dermatitis, hair loss, bone deformation, and fracture. Concentrations of 0.(XX)1% and lower were nontoxic. This suggests that topical applications of this agent in man may not be of clinical use because of the observed toxicity. 

Unusual responses to therapy have been that palmoplantar blistering was enhanced by etretinate during therapy of patients with keratoderma palmaris et plantaris (epidermolytic type), epidermolytic hyperkeratosis, and pachyonychia congenita. Patients with Hailey-Hailey disease and atopic dermatitis have worsened with both retinoids. 

Step II is the daily skin care program using cleansing granules, alpha hydroxyl acid toners and vitamin A conditioning lotions to accelerate the jjroduction of new skin cells. These three skin care formulations are used daily. However, patients with dry skin or who live in a dry climate start slowly, skijjping days as needed to avoid retinoid dermatitis. 

The expected duration of erythema after a chemical peel is dependent on the depth of injury of the peeling solution. With medium-depth peels, erythema is usually resolved by the second month. However, if hot spots of redness are noted, we will generally have the patient apply a medium potency topacal steroid two to three times daily for a few days. In a scenario where early postpeel erythema is accompanied by burning, stinging or itching, contact dermatitis (to retinoids, other compxjnents of the home regimen or aerosol chemical irritants), incipaent... 

Retinoids cause a variable amount of irritation, more properly a heightening of cutaneous reactivity termed retinoid dermatitis, early in therapy [39-42,44]. In the first few weeks approximately 80% of patients experience stinging, hyperesthesia or pruritus, fine scaling, dryness and mild erythema (Fig. 7). These effects are dose-dependent and peak within the first month of therapy. Weiss et al. reported 92% incidence with 0.1% tretinoin and Leyden et al. a 70% incidence using 0.05% tretinoin. However, in a double blind, vehicle controlled study of 179 patients, only 4% of patients using Renova discontinued the medication as a result of adverse reactions [57]. Retinoid dermatitis usually improves markedly during the course of treatment but may not completely disappear. Other side effects are rare. 

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