Tretinoin ointment

Side effects associated with use of topical tretinoin ointment include transient hyperemia, irritation, or burning. Ocular pharmacokinetic studies in rabbits show low levels of drug in the aqueous humor after topical application of [ H]-tretinoin, with major tissue uptake in the surface epithelium and the iris. Because retinoic acid has poor stability in the presence of light and oxygen and is insoluble in water, its formulations and clinical use are limited. Although it is capable of reversing squamous metaplasia and keratinization, these ocular surface changes are seen only in severe, not mild to moderate, cases of dry eye. 

Topical tretinoin has also been used as an ophthalmic ointment 0.01% in the treatment of squamous metaplasia associated with dry eyes. In 161 patients with either keratoconjunctivitis sicca or conjunctival cicatricial diseases (Stevens-Johnson syndrome, inactive pemphigoid, radiation-induced dry eye, drug-induced pseudopemphigoid, and toxic epidermal necrolysis) there were no beneficial effects in the former, but significant reversal of conjunctival kerati-nization in the temporal bulbar site in the latter (1). Adverse effects were hmited to blepharoconjunctivitis and resolved on withdrawal. 

Ocular findings are among the more frequent adverse effects in patients taking isotretinoin (46,47), the most common being blepharoconjunctivitis, which also occurs in those who use tretinoin ophthalmic ointment (1). 

The aqueous solubility of the active substance is important when choosing between an aqueous gel or a fatty mouth paste or ointment. Lidocaine is used as the hydrochloride in lidocaine gels (see Table 7.2). Tretinoin may be formulated in a hypromellose 20 % (adhesive) ointment, see Table 7.7. 

Bacitracin/polymyxin B ointment and other types of occlusive ointment enhance wound healing. Conversely, iodine, tretinoin and fluoiinated corticosteroids and... 

Kaidbey, K. H., Petrozzi, J. W. and Klig-man, A. M. (1975) Treatment of psoriasis with topically applied tretinoin and steroid ointment. Arch. Derm., Ill, 1001. 

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