Glycolic acid tretinoin

Patients of varying skin types (1-V) having striae distensae alba on the abdomen or thighs can apply topical 20% glycolic acid daily to the entire treatment area. In addition, these patients apply 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine to half of the treatment area and 0.05% tretinoin emollient cream to the other half of the treatment area. The creams are applied on a daily basis for 12 weeks. Improvement is evaluated at 4 and 12 weeks with increased elastin content within the reticular and papillary dermis [14]. 

Following the peel the skin is carefully observed for any complications such as hyperpigmentation and infection. Results are maintained with serial peels and by using at-home tretinoin or glycolic acid, as well as by sun avoidance. 

Ash K, Lord J, Zukowski M, McDaniel DH (1998) Comparison of topical therapy for striae alba (20% glycolic acid/ 0,05% tretinoin versus 20% glycolic acid/ 10% L-ascorbic acid). Dermatol Surg 24(8) 849-856... 

TCA 10-30% Tretinoin Salicylic Acid Glycolic Acid Jessner s Solution... 

Tretinoin 1% has also been used as a chemical peeling agent [22,23]. The efficacy of tretinoin peels was compared with glycolic acid peels in the treatment of melasma in dark skinned patients [23]. In a split face study of ten Indian women, 1% tretinoin was applied to one half of the face, while 70% glycolic acid was applied to the opposite side. Peels were performed weekly. Significant improvement occurred on both sides as assessed by photographs and a Modi-... 

Khunger N, Sarkar R, Jain RK (2004) Tretinoin peels versus glycolic acid peels in the treatment of melasma in dark-skinned patients. Dermatol Surg 25 270-273... 

The concomitant use of various bleaching agents has also been shown to improve PIH. In 1975, tretinoin in combination with hydroqui-none and dexamethasone was reported as an effective treatment for PIH [14]. In a small study, the application of 2% hydroquinone and 10% glycolic acid gel twice daily and 0.05% tretinoin cream at night has been shown to provide benefit for darker-skinned patients with PIH [15]. Similarly, Yoshimura et al. [16] suggested efficacy of tretinoin combined with hydroquinone and lactic acid in reducing PIH. More re-... 

The choice of one or another of these molecules depends on the condition of the patient s skin. Tretinoin is not used if the patient has many telangiectasias AHAs are avoided if the skin is very thin. Conversely, the two products can be mixed in the same prescription, in variable concentrations, depending on the skin type and the desired effect. The concentration of tretinoin would be increased to stimulate reepithelialization the concentration of glycolic acid would be increased to improve and even out transcorneal penetration. 

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. 

This is worthwhile when the patient is willing and when it is carried out imder medical supervision. Unsupervised or secret use of aggressive products by the patient can sometimes cause problems for the doctor who has not been informed of the patient s self-administered treatment. The doctor should watch out for unacknowledged use of tretinoin or other retinoids, concentrated glycolic acid, benzoyl peroxide, or any other product that increases penetration of the acids, making them penetrate more quickly and deeply than originally intended. Some patients can... 

Retinoids induce neoangiogenesis, whereas AHAs act on the dermis without necessarily going through a phase of inflammatory reaction. We can therefore assume that their combined effects can produce better results at the same time as reducing the incidence of side-effects thanks to the use of lower doses of each of these two potential irritants. For example, if there is resistance to (daily or twice daily) monotherapy with tretinoiff at 0.1%, applying an 8-10% glycolic acid gel beforehand helps the retinoid to penetrate more efticiently. Tretinoin and AHAs can be applied separately, but they can also be mixed in the same gel. 

If, on the other hand, a patient cannot tolerate a concentration of tretinoin at 0.05%, applying an 8-10% glycolic acid cream in the morning will make a tretinoin cream at 0.015% applied in the evening more effective, at the same time as reducing the irritation caused by the retinoid. These combinations must always be used under close medical supervision, however, as in dual therapy, skin reactions can be highly unpredictable and severe in some patients. More sensitive skins can be treated as follows ... 

The doses of each product should be increased gradually thereafter. If the patient has a tendency to erythema, photosensitivity or telangiectasias, the glycolic acid should be increased and the concentration of the tretinoin decreased. 

If the patient has thin skin, the tretinoin should be increased more quickly than the glycolic acid. 

In the evening, a 0.05% tretinoin cream should be applied (see Chapter 2). This cream reduces the thickness of the stratum corneum and provides a deeper peel with the same concentration. A 10% (non-photosensitizing) glycolic acid gel could be applied on younger women in the morning. 

Another argument that counters the claim that lower concentrations are more effective is that the application technique for a TCA mask involves degreasing the skin and applying glycolic acid or tretinoin beforehand. This makes the skin far more permeable and enhances the penetration of the TCA, " which means being very careful about how long the paste remains in contact with the skin. 

Substituting 0.1% tretinoin with 10% glycolic acid removes an irritant and potentially photosensitizing factor at the same time as enhancing penetration and therefore the effectiveness of hydroquinone. 

Glycolic acid Jessner s solution Pyruvic acid Resorcinol Salicylic acid Trichloroacetic acid Tretinoin Malic acid Deep chemical peels... 

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