Tretinoin comparative

In another comparison of the efficacy and adverse effects of adapaiene gel 1% or 0.025% tretinoin gel in 150 Chinese patients, similar effects were observed (19). In both groups skin irritation was mild, but it was more pronounced with tretinoin. Burning was the most common unwanted effect in those who used tretinoin compared with adapaiene (34 versus 11%). There was dryness of the skin in 34% of those who used tretinoin and in 22% of those who used adapaiene. The respective frequencies of scaling were 26 and 15%, and of erythema 26 and 2.7%. Pruritus was the only adverse effect experienced exclusively by those who used adapaiene, and it occurred in under 4%. Overall, 46% of those who used tretinoin had some form of irritation, compared with 32% of those who used adapaiene. 

Tretinoin microsphere gel 0.1% has been assessed in a 6-month, randomized, double-blind, placebo-controlled study involving 45 patients with moderate-to-severe facial photodamage. After 6 months, the overall severity of photodamage was significantly improved with tretinoin, compared with placebo. Adverse effects included a higher frequency of increased cutaneous irritation at 1 month for tretinoin versus placebo however, after 6 months, only peeling and dryness were significantly increased [20]. 

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-... 

Comparative studies on the bioavailability of three different tretinoin gel formulations showed that the dimensions of the sampling area may play a critical role in determining the extent of dermal drug uptake [33, 34], If, by lateral spreading, a substance is distributed over an area sufficiently larger than the sampling area, significant proportions of compound will not be recovered and hence permeability will be underestimated. 

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],... 

In a retrospective study, 22 children taking tretinoin (median age 9.3 years, range 1.8-16.3) for a median of 38 (6-138) days were compared with 22 taking conventional therapy (median age 12.3 years, range 3.2-16.7) (25). Overall, 12 of 22 patients had sjrmptoms associated with tretinoin (Table 2). Three developed the retinoic acid syndrome. 

Extramedullary relapse of acute promyelocytic leukemia, which is rare after chemotherapy alone, was more common after tretinoin, but it is not clear whether it truly increases the risk of extramedullary recurrence and what the risk factors are. In a retrospective analysis of the incidence of extramedullary relapse in patients after prior treatment with tretinoin and in patients previously treated with chemotherapy alone (68) three of the 13 patients who received tretinoin had extramedullary involvement compared with none of the 11 patients previously treated with chemotherapy alone (RR = 2.1 Cl = 1.34, 3.29). The retinoic acid syndrome during prior induction treatment was significantly associated with extramedullary relapse (three of five patients with the retinoic acid syndrome versus none of eight without the syndrome (RR = 5.0 Cl = 1.4,17)). Thus, tretinoin may predispose patients with acute promyelocytic leukemia to extramedullary involvement at relapse and the retinoic acid syndrome is a risk factor. 

Oral isotretinoin (9-a s-retinoic acid) is often used in treating severe or stubborn acne rosacea. A 1994 study compared the treatment of rosacea with 10 mg/day low-dose oral isotretinoin, 0.025% low-dose topical tretinoin and a combination of the two. The results showed that before the 16th week of treatment, isotretinoin was more effective, but that afterwards there was no difference between tretinoin and isotretinoin. The combination of systemic and topical treatment does not give any further improvement in low doses. 

In a 12-week study of tretinoin, the reduction of lesion counts ranged from 32% to 81% for noninflammatory lesions, and 17% to 71% for inflammatory lesions (22% to 83% for the total lesion count). Comparing tretinoin 0.025% gel or 0.025% cream with vehicles only in a once-daily application regimen, tretinoin was significantly more effective in reducing both inflammatory and noninflammatory lesions. ... 

Two reformulations of tretinoin include a porous bead (0.01% gel) (microspheres) and liquid polymer (0.025% cream and 0.025% gel). These are less irritating than standard vehicles for tretinoin. In the topical gel formulation containing polyolprepolymer-2, tretinoin penetration was signiflcantly reduced while epidermal deposition was enhanced, compared with a commercially available gel preparation at the same concentration. Polyolprepolymer-2 promotes retention of drug molecules on the skin surface and in the upper layers of the skin. ... 

Adapalene, a third-generation retinoid, is a retinoid-mimetic com-ponnd (a naphthoic acid derivative), available as 0.1% gel, cream, alcoholic solntion, and pledgets. It has selective affinity for retinoic acid receptor (RAR) subtypes RAR- 8 and RAR-y fonnd in the epidermis," " " and has comedolytic, keratolytic, and anti-inflammatory activity. " " " Vehicle-controlled and comparative stndies have demonstrated the utility of adapalene in treatment of acne." " " Adapalene is indicated for mild to moderate acne vnlgaris. Adapalene 0.1% gel may be used as an alternative to tretinoin 0.025% gel to achieve better tolerability in some patients." " Adapalene coadministered with a topical or oral antibiotic represents arational therapy for moderate forms of acne."... 

Once-daily tazarotene gel may be more effective than once-daily tretinoin in redncing papnles and open comedones, with eqnal efficacy against closed comedones. " Efficacy is comparable to adapalene, bnt its local tolerance by daily application is similar to tretinoin. In addition, tazarotene was stndied for its efficacy with short contact application. Once-daily short contact applications signiflcantly rednced irritation potential, yet maintained therapeutic equivalency to standard application regimens. ... 

Retinaldehyde is biotransformed into all-frani -retinoic acid and induces biologic effects including comedolytic activity similar to those of topical tretinoin when administered at comparatively lower concentrations. ... 

Retinoyl-/3-glucuronide is a naturally occurring, biologically active metabolite of vitamin A. A 0.16% retinoyl- 8-glucuronide cream has been shown to be effective against inflammatory and noninflammatory acne lesions with comparable efficacy to tretinoin, but with less irritation potential and comparatively fewer other adverse effects than with tretinoin. 

Lucky A, Cullen S, Jarratt M, Quigley JW. Comparative efficacy and 60. safety of two 0.025% tretinoin gels results from a multicenter, double-... 

As with ALL, the goal of remission induction for AML is to rapidly induce a CR. Compared to ALL, however, fewer patients with AML achieve CR. Since the CR rate in AML is related to the intensity of the remission induction regimen, the drugs used in AML are given at doses that uniformly cause severe marrow hypoplasia (except tretinoin). One reason for the lower CR rate in AML as compared to ALL is the inability to give optimal doses of chemotherapy because of marrow toxicity. With continued improvement of supportive care for patients... 

A number of clinical trials have evaluated optimum treatment regimens for APL since the discovery of tretinoin. These trials have demonstrated that tretinoin induction therapy, followed by consolidation chemotherapy, produced similar CR rates but decreased relapse and increased EPS and OS as compared to chemotherapy alone for induction and consolidation. 28 However, a significant proportion of patients receiving tretinoin in that study relapsed by 4 years,... 

Unlike other subtypes of AML, the role of maintenance therapy is well defined in APL. Before the advent of tretinoin, nonrandomized trials supported a benefit of continnons low-dose methotrexate and mercaptopurine in prevention of relapse of APL. Larger prospective trials have demonstrated decreased relapse rates in patients who received maintenance therapy (either tretinoin or combination chemotherapy), and some trials have demonstrated increased EFS and OS. ° In a smdy that compared maintenance with tretinoin, tretinoin plus chemotherapy, and chemotherapy or observation, observation was associated with the highest relapse rate and tretinoin plus chemotherapy with the lowest relapse rate. Current recommendations for maintenance therapy in adult APL patients includes tretinoin 45 mg/m per day for 15 days every 3 months, in addition to mercaptopurine 100 mg/m orally daily and methotrexate 10 mg/m per week, for 2 years in aU... 

In a double-blind study of photodamaged skin, it has been demonstrated that papillary dermal collagen I formation was reduced by 56% in photodamaged skin compared with sun-protected skin [19]. Compared with vehicle, treatment with 0.1% tretinoin resulted in an 80% increase in Type I collagen formation, whereas the vehicle-treated areas showed a decrease in collagen formation. 

In an evaluation of the efficacy of tretinoin in the treatment of hyperpigmented lesions associated with photoaging in Asian (Chinese and Japanese) patients, 45 photoaged Asian patients were randomized to treatment with tretinoin or vehicle for 40 weeks [17]. At the end of the treatment period, hyperpigmented lesions of the face and hands were lighter or much lighter in 90% of the tretinoin group, compared with... 

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