GENERIC NAME: TRETINOIN
BRAND NAME: Retin-A, Atralin, Renova, Avita, Altinac
DRUG CLASS AND MECHANISM: Tretinoin is a derivative of vitamin A. Topical tretinoin is used in the treatment of mild to moderate acne and on skin that has been damaged by excessive exposure to the sun. Tretinoin irritates the skin and causes the cells of the skin to grow (divide) and die more rapidly, increasing the turnover of cells. The number of layers of cells in the skin actually is reduced. In patients with acne, new cells replace the cells of existing pimples, and the rapid turnover of cells prevents new pimples from forming. By a similar mechanism, tretinoin can reduce some wrinkles, areas of darkened skin, and rough areas of skin, all of which occur in sun-damaged skin. In patients with sun-damaged skin, improvements in the skin usually are seen within the first 3 to 4 weeks of treatment. Brown spots begin to fade after six to eight weeks. Wrinkles decrease or disappear after three to six months. Following application to the skin, a minimal amount of drug is absorbed into the body. The FDA approved topical tretinoin in 1971.

PRESCRIPTION: yes

GENERIC AVAILABLE: yes

PREPARATIONS: Gel: 0.01%, 0.025%, 0.04%, 0.05%, 0.1%. Cream: 0.02%, 0.025%, 0.05%, 0.1%.

STORAGE: Store between 15° and 25°C (59°-77°F).

PRESCRIBED FOR: Topical tretinoin is used for treating mild to moderate acne, fine wrinkles and hyperpigmentation.

DOSING: Before applying topical tretinoin, the affected area of the skin should be cleansed with soap and dried. Patients should then wait 20 to 30 minutes before applying tretinoin, gently rubbing it into the affected area. The hands should be washed immediately after application. Tretinoin is usually applied once daily, in the evening.

DRUG INTERACTIONS: Combining other topical acne medications (for example, salicylic acid) with tretinoin may lead to excessive skin irritation. Use of abrasive soaps or cleansers, astringents, skin waxes and other products that irritate the skin may add to tretinoin induced skin irritation. Medications [for example, tetracycline (Achromycin)] that cause sun sensitivity should not be combined with tretinoin because of additive sun sensitivity.

PREGNANCY: There are no adequate studies of topical tretinoin use during pregnancy. Physicians must weigh the potential risks and benefits before prescribing tretinoin during pregnancy.

NURSING MOTHERS: It is unknown whether tretinoin is distributed into breast milk. It is also unknown if topically applied tretinoin accumulates to an extent sufficient to pose a concern in the infant. Nonetheless, since oral tretinoin is not recommended during lactation, it probably is prudent to avoid nursing during treatment with topical tretinoin.

SIDE EFFECTS: Following the application of tretinoin to the skin, there often is local inflammation. This reaction disappears when treatment is stopped. Mild stinging or a sensation of warmth also can occur when applying tretinoin. Dryness, scaling, and redness occur frequently. If severe redness, vesicles or crusting develops, a physician should be notified immediately and tretinoin stopped. It may be possible to restart therapy with a lower concentration.

Some patients using tretinoin develop increased sun sensitivity and are more prone to sunburn (photosensitivity). Therefore, it is advisable to avoid exposing treated areas of the skin to excessive sunlight or UV lamps to reduce the risk of severe sunburn.

USES: This medication is used in the treatment of acne. It reduces the formation of pimples and promotes quick healing of pimples that do develop.

HOW TO USE: Patient instructions are available with the product. Read them carefully before using. Apply a thin layer to affected area at bedtime. Use a gauze pad or cotton swab to apply the liquid. Wash hands immediately after use. Using this medication more frequently or in excessive amounts does not improve the results, but may increase side effects. Avoid applying near the eyes, mouth, or open cuts since this medication can irritate sensitive skin. Even though acne may appear to worsen when the medication is first used, continue therapy. It may take three to six weeks before the full benefits of this medication are seen.

SIDE EFFECTS: Immediately after applying, the skin may feel warm or mild stinging or redness may occur. Some peeling of the skin may occur. These effects should subside as your skin adjusts to the medication. If they persist or become bothersome, inform your doctor. This medicine may also increase sun sensitivity. Notify your doctor if you experience: blistering, crusting, redness, severe burning or swelling of the skin. If you notice other effects not listed above, contact your doctor or pharmacist.

PRECAUTIONS: This medication can increase sensitivity to sunlight, wind and cold. Avoid prolonged exposure to the sun and sunlamps. Wear protective clothing and use an effective sunscreen. Use mild soap when washing your face. Do not wash face excessively. Abrasive soaps, cleansers, medicated creams or lotions can increase skin irritation. Consult your doctor or pharmacist about their use. Use other acne preparations with caution while using this medication. This medication is not recommended for use during pregnancy. Consult your doctor for more details. It is not known if this medication passes into breast milk. Consult your doctor before breast-feeding.