III. Preparations

  1. Standard preparations
    1. Cream 0.025% 0.05% 0.1%
      1. Cream 0.025% is as effective and less irritating than .05-.1%
      2. Lower concentration simply takes a little longer for improvement
    2. Gel 0.01%, 0.025% 0.005%
    3. Lotion 0.05% (Avoid - VERY irritating)
  2. Less irritating agents
    1. Retin-A Micro (Tretinoin gel microsphere)
    2. Avita (Tretinoin 0.025%)

IV. Dosing: Directions for use

  1. Apply one dot (split-pea size) per one triangle of face (forehead, right malar, left malar)
  2. Initially apply only for a few hours
    1. Slowly increase length of treatment
    2. Titrate up to overnight application as tolerated
  3. Often used with Topical Antibiotics (e.g. Clindamycin)
    1. Clindamycin reduces irritating effect of Tretinoin
    2. Example schedule
      1. Morning: Clindamycin applied
      2. Evening: Tretinoin applied

V. Adverse Effects

  1. Scaling
  2. Skin dryness
  3. Local irritation, erythema or inflammation
    1. Creams irritate less than lotions
    2. Irritation can be reduced by adding Hydrocortisone
      1. 1 part Retin A 0.025%, 1 part Hydrocortisone 1%
  4. Local skin sensation of burning or stinging
  5. Local Pruritus
  6. Photosensitivity
  7. Initially exacerbates inflammatory lesions

VI. Safety

  1. Pregnancy Category C

VII. Efficacy

  1. Most potent Comedolytic
  2. Good results in 75% of patients in 3 months

VIII. Mechanism

  1. Comedolytic
  2. Lowers cohesiveness of follicular epithelial cells
    1. Decreases micro-comedo formation
  3. Increases follicular cell turnover
    1. Results in extrusion of existing comedones

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Cost: Medications

tretinoin (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
TRETINOIN 0.01% GEL Generic $4.45 per gram
TRETINOIN 0.025% CREAM Generic $3.53 per gram
TRETINOIN 0.025% GEL Generic $4.36 per gram
TRETINOIN 0.05% CREAM Generic $4.61 per gram
TRETINOIN 0.05% GEL Generic $5.55 per gram
TRETINOIN 0.1% CREAM Generic $5.37 per gram
TRETINOIN GEL MICRO 0.04% PUMP Generic $10.27 per gram
TRETINOIN GEL MICRO 0.04% TUBE Generic $11.29 per gram
TRETINOIN GEL MICRO 0.1% PUMP Generic $10.17 per gram
TRETINOIN GEL MICRO 0.1% TUBE Generic $11.28 per gram
retin-a (on 6/22/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
RETIN-A MICRO PUMP 0.08% GEL $17.52 per gram

Ontology: Tretinoin (C0040845)

Definition (CHV) a drug used to treat acne
Definition (CHV) a drug used to treat acne
Definition (CHV) a drug used to treat acne
Definition (CHV) a drug used to treat acne
Definition (CHV) a drug used to treat acne
Definition (NCI_NCI-GLOSS) A nutrient that that body needs in small amounts to function and stay healthy. All-trans retinoic acid is made in the body from vitamin A and helps cells to grow and develop, especially in the embryo. A form of all-trans retinoic acid made in the laboratory is put on the skin to treat conditions such as acne and is taken by mouth to treat acute promyelocytic leukemia (a fast-growing cancer in which there are too many immature blood-forming cells in the blood and bone marrow). All-trans retinoic acid is being studied in the prevention and treatment of other types of cancer.
Definition (NCI) A naturally-occurring acid of retinol. Tretinoin binds to and activates retinoic acid receptors (RARs), thereby inducing changes in gene expression that lead to cell differentiation, decreased cell proliferation, and inhibition of tumorigenesis. This agent also inhibits telomerase, resulting in telomere shortening and eventual apoptosis of some tumor cell types. The oral form of tretinoin has teratogenic and embryotoxic properties.
Definition (NCI_CRCH) Retinoid with a carboxylic acid group.
Definition (MSH) An important regulator of GENE EXPRESSION during growth and development, and in NEOPLASMS. Tretinoin, also known as retinoic acid and derived from maternal VITAMIN A, is essential for normal GROWTH; and EMBRYONIC DEVELOPMENT. An excess of tretinoin can be teratogenic. It is used in the treatment of PSORIASIS; ACNE VULGARIS; and several other SKIN DISEASES. It has also been approved for use in promyelocytic leukemia (LEUKEMIA, PROMYELOCYTIC, ACUTE).
Definition (PDQ) A naturally-occurring acid of retinol. Tretinoin binds to and activates retinoic acid receptors (RARs), thereby inducing changes in gene expression that lead to cell differentiation, decreased cell proliferation, and inhibition of tumorigenesis. This agent also inhibits telomerase, resulting in telomere shortening and eventual apoptosis of some tumor cell types. The oral form of tretinoin has teratogenic and embryotoxic properties. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41258&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=41258&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C900" NCI Thesaurus)
Concepts Vitamin (T127) , Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D014212
SnomedCT 332319008, 327389004, 387305002, 54972005
English Acid, Retinoic, Acid, trans-Retinoic, Acid, Vitamin A, Retinoic Acid, trans Retinoic Acid, trans-Retinoic Acid, Vitamin A Acid, Acid, all-trans-Retinoic, all trans Retinoic Acid, all-trans-Retinoic Acid, (All-E)-3,7-Dimethyl-9-(2,6,6-trimethyl-1-cyclohexen-1-yl)-2,4,6,8-nonatetraenoic Acid, tretinoin, All-trans Vitamin A Acid, Trans Vitamin A Acid, All-trans Retinoic Acid, Trans Retinoic Acid, Tretinoinum, beta-Retinoic Acid, Tretinoin [cytostatic], Tretinoin [skin], tretinoin (medication), retinoids tretinoin, TRETINOIN, Tretinoin [Chemical/Ingredient], all trans retinoic acid, all-trans-retinoic acid, vitamin a acid, Tretinoin [skin] (product), Tretinoin [cytostatic] (product), trans-Retinoic acid, all trans-Retinoic acid, vitamin A acid, Vitamin A acid, all-trans-, all-trans-Vitamin A acid, ATRA, retinoic acid, all-trans-Retinoic acid, all-trans retinoic acid, 3,7-dimethyl-9-(2,6,6-trimethylcyclohexen-1-yl)-2,4,6,8-nonatetraenoic acid, 2,4,6,8-Nonatetraenoic acid, 3, 7-dimethyl-9-(2,6,6-trimethyl-1-cyclohexen-1-yl)-, (all-E)-, Retinoic acid, Vitamin A acid, Tretinoin (product), Tretinoin (substance), TRA, Tretinoin [cytostatic] (substance), Tretinoin [skin] (substance), Tretinoin
German Trans-Retinsäure, All-trans-Retinsäure, Tretinoin, Retinsäure, Vitamin-A-Säure
Swedish Tretinoin
Czech tretinoin, kyselina retinová
Finnish Tretinoiini
Russian TRETINOIN, RETINOEVAIA KISLOTA, VITAMIN A-KISLOTA, ВИТАМИН A-КИСЛОТА, РЕТИНОЕВАЯ КИСЛОТА, ТРЕТИНОИН
Japanese トレチノイン, ベサノイド, ビタミンA酸, レチノイン酸
French Vitamine A acide, Acide tout trans rétinoïque, Acide rétinoïque tout trans, Trétinoïne
Italian Acido trans-retinoico, Acido tutto-trans-retinoico, Acido retinoico, Tretinoina
Croatian TRETINOIN
Polish Kwas retynowy, Tretynoina
Portuguese Ácido Retinoico, Ácido da Vitamina A, Tretinoína
Spanish tretinoína (citostático), tretinoína (citostático) (producto), tretinoína (uso dermatológico), tretinoína (uso dermatológico) (producto), tretinoína (piel) (producto), tretinoína (piel), tretinoína (producto), tretinoína (sustancia), tretinoína, ácido de vitamina A, ácido retinoico, Tretinoina, Ácido Retinoico, Ácido de Vitamina A

Ontology: Retin-A (C0593762)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D014212
English Retin A, retin-a, retin a, retin, a retin, Retin-A-Micro, Retin-A
German Retin-A