Skin treatments tretinoin

People who use tretinoin often report that their skin is more sensitive to the sun and burns more easily. This photosensitization is better explained by the thinning of the stratum corneum rather than by a photochemical reaction between the tretinoin and the sun s rays. It is therefore essential to recommend the use of a sunscreen (SPF 25-50 UVA + UVB + HSP induction) to patients being treated with tretinoin. It should also be borne in mind that there is a potential risk of skin cancers developing as a result of the stratum corneum thinning and the enhanced penetration of the sun s rays. Nevertheless, it appears that patients on longterm tretinoin treatment do not have a higher incidence of skin cancers. Tretinoin has in fact proved to be effective in the treatment of photoaging and actinic keratoses. 

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]. 

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... 

Weinstein GD, Nigra TP, Pochi PE et al (1991) Topical tretinoin for treatment of photodamaged skin a multicenter study. Arch Dermatol 127 659-665... 

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 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. 

Weinstein GD et al Topical tretinoin for treatment of photodamaged skin. Arch Dermatol 1991 127 659. [PMID 2024983]... 

Noble, S. andWagstaff, A.J., Tretinoin. A review of its pharmacological properties and clinical efficacy in the topical treatment of photodamaged skin, Drugs. Aging, 6, 479,1995. 

Tretinoin cream is used extensively for the treatment of acne and photodamaged skin, and local irritant dermatitis is common. With normal use, absorption is minimal and systemic adverse effects are therefore not expected. 

The adverse effects of tretinoin 50 mg/m /day for 3 months have been studied in 20 patients with emphysema in a randomized, double-blind, placebo-controlled trial (10). The treatment was well tolerated and associated with only mild adverse effects, including skin changes, such as dry skin and cracking lips in 15 (1 placebo), transient headache in 13 (1), hyperhpidemia in 11 (5), pruritus in 6 (2), muscle/bone pain in 6 (0), generalized fatigue in 6 (2), raised transaminases in 5 (1), a sensation of clogged ears in 3 (2), nausea in 2 (0), hair loss in 2 (0), and blurred vision in 1 (1). 

Tretinoin is usually applied as a 0.05% polyethylene glycol (PEG)-400/ethanol liquid or a 0.05% hydrophilic cream. Daily application results in inflammation, erythema, and peeling of the skin. After 3 to 4 weeks. pu.stular eruptions may be seen, causing the expulsion of microcomedones. Treatment may then be changed to applications every 2 or 3 day.s. Because the homy layer is thinned, the skin is mote susceptible to irritation by chemical or physical abuse. Thus, it is recommended that other kerolytic agents (.salicylic, sulfur, resorcinol, benxoyl peroxide) be discontinued before beginning treatment with tretinoin. 

The application of topical tretinoin improves senile atrophy of the skin a decrease in cell abnormalities and dysplasias can be seen, as well as an antitumor effect that persists after the end of treatment if it has been administered correctly and for a sufficiently long period. ... 

Post-inflammatory hyperpigmentation is also improved by tretinoin, as proved clinically, histologically and by colorimetry, in a study by Bulengo-Ransby et aP on subjects with black skin. A 40% improvement can be expected after 40 weeks of treatment with 0.1% tretinoin. In the treatment of melasma, topical 0.1% tretinoin was studied in comparison with the vehicle alone in black patients. A 10-month treatment lightened the melasma by 32% (an improvement factor established both clinically and by colorimetry). 

One stud)P showed that a tretinoin concentration of 0.01% is effective for the face, hands and forearms, whereas another showed that there is no difference between placebo, 0.01% tretinoin and 0.001% tretinoin. A concentration between 0.05% and 0.1% is, on the other hand, always considered active. The average concentration used is 0.05%, but different skin types or sensitivities may require different concentrations, and it is recommended to start any treatment with a trial dose of 0.02% or 0.03%. 

Formulations in alcohol gels dry out the skin, increase the penetration of the tretinoin and make the treatment more uncomfortable. Gels should only be used on thick and oily skins. 

If the skin is not properly hydrated during treatment with tretinoin, it will usually flake visibly and fairly rapidly after a few days of treatment. 

Erythema is to be expected with effective tretinoin treatment. This is not an adverse effect, but rather is collateral and natural. The skin of a patient properly treated with tretinoin is pinker than normal, and this provides the doctor with an essential means of observation a patient showing no erythema is undertreated or incorrectly treated. 

After a peel, the skin needs to heal as quickly as possible in order to maintain homeostasis of the whole organism. Tretinoin accelerates re-epithelialization if used before the peeling. For this it must be used at a dose of 0.05%-0.1%, sometimes to the point of irritative dermatitis. Ideally, the treatment should start 3-4 weeks before a TCA-SAS peel. It is accepted scientifically that the preventive application of tretinoin promotes post-peel healing of the skin. In contrast, applying tretinoin during the post-peel period appears to slow down skin regeneration. Not all peels require this help with re-epitheliazation. 

Andreano IM, Bergfeld WF, Medandorp SV. Tretinoin emollient cream 0.01% for the treatment of photoaged skin. Cleve Clin J Med 1993 60 49-55. 

---