Drugs

How does tretinoin work?

how does tretinoin work

Tretinoin is a prescription retinoid used to treat acne and other skin concerns.  How does tretinoin work, what is it used for, and what are the potential benefits and side effects?

What is tretinoin?

Tretinoin is prescribed by a doctor, and it can either be applied topically or taken orally as isotretinoin capsules (Accutane ®).  For simplicity, this article will focus on topical tretinoin therapy and how it works. Topical tretinoin, sold under brand names such as Retin A, Altreno, and others, is available as a cream, lotion, gel, or liquid solution, and concentrations range from 0.01% to 0.1%.1  Tretinoin may also be prescribed simultaneously with antibiotics to treat specific types of acne, and it may be a part of some combination therapies, such as clindamycin/tretinoin gel.2

Tretinoin is a form of retinoic acid, which is a derivative of vitamin A, and it has been around to treat a variety of conditions since the 1960s.3  Topical tretinoin is approved by the FDA to treat acne vulgaris as well as treat signs of photoaging, such as fine wrinkles, roughness, and some types of hyperpigmentation.1,4  It is also sometimes prescribed off-label to treat other skin concerns. 

How does tretinoin work?

Although the exact mechanism of how topical tretinoin works is unknown, current research suggests that tretinoin, when applied to the skin, binds to nearby retinoic acid receptors.5  This may be responsible for activating a variety of different functions, such as reducing buildup of keratin in sebaceous ducts and encouraging collagen production.5  More research is needed to determine exactly how tretinoin works and how it can be optimized to be as beneficial as possible.

Excess keratin buildup in the sebaceous ducts can play a role in the development of some types of acne, so targeting this pathway may help treat and prevent acne in some people.6, 8.   Additionally, by enhancing collagen production and skin cell turnover, tretinoin could potentially help reduce signs of photoaging in some people, such as wrinkles and sun spots.7  Speaking with a healthcare provider could help you determine whether tretinoin would work for your unique skin type and concerns.

What are the side effects of tretinoin?

Some common side effects of using topical tretinoin include excessive skin dryness, redness, flaking, and a scaly appearance of the skin.4  This is usually most prominent in the first few weeks of using topical tretinoin, and it often subsides after a few weeks of use.4  Using tretinoin may also be associated with increased sun sensitivity, so it is especially important to limit sun exposure and use broad-spectrum sunscreens that protect against UVA and UVB radiation.4 

It is important to tell your doctor or pharmacist about any side effects you are concerned about; they may want to alter the strength of the tretinoin or discontinue it altogether.  Seek medical help immediately if you experience signs of an allergic reaction after using the medication, such as hives, chest tightness, and swelling of the face, mouth, or throat.

Although oral isotretinoin cannot be used during pregnancy due to a risk of birth defects for the developing fetus, the evidence of this occurring with topically-applied tretinoin is inconclusive as a minimal amount of tretinoin is actually absorbed into the bloodstream.9  Since the consensus on this remains relatively unknown, it is generally not recommended to use tretinoin during pregnancy, so it is important to discuss this possibility with your doctor.10

Some other topical medications and skincare ingredients may not mix well with tretinoin; for example, applying benzoyl peroxide at the same time as some forms of topical tretinoin may reduce the effectiveness of the tretinoin.11  Since tretinoin can cause irritation and dryness of the skin where it is applied, your doctor may not recommend using other drying skincare ingredients when you start using topical tretinoin.12

Tretinoin may also interact with certain oral medications, so it is important to tell your doctor about all products, supplements, and medications you may be using.  This article is not medical advice, and it is not intended to prescribe, diagnose, or promote specific treatments for any condition.  Consult your doctor or another qualified healthcare provider for your unique skin needs.

References

  1. Yoham, A.L., Casadesus, D. (2020, December 5).  Tretinoin. StatPearls [Internet]. Accessed online 2021, May 5, from https://www.ncbi.nlm.nih.gov/books/NBK557478/
  2. Oschendorf, F. (2015, June 7). Clindamycin phosphate 1.2% / tretinoin 0.025%: a novel fixed-dose combination treatment for acne vulgaris. Journal of the European Academy of Dermatology and Venereology 29(5): 8-13. Doi: 10.1111/jdv.13185
  3. Stuttgen, G. (1986, October). Historical perspectives of tretinoin. Journal of the American Academy of Dermatology 15(4): 735-740. Doi: 10.1016/S0190-9622(86)70228-4.
  4. Mukherjee, S., et al (2006, December). Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging 1(4): 327-348. Doi: 10.2147/ciia.2006.1.4.327
  5. Baldwin, H.E., Nighland, M., Kendall, C., et al (2013, June 1). 40 years of topical tretinoin use in review. Journal of Drugs in Dermatology: JDD 12(6): 638-642. Accessed 2021, May 13, from https://europepmc.org/article/med/23839179
  6. Botros, P.A., Tsai, G., Pujalte, G.G.A. (2015). Evaluation and Management of Acne. Prim Care Clin Office Pract 42: 465-471. Doi: 10.1016/j.pop.2015.07.007
  7. Kang, S., Fisher, G.J., Voorhees, J.J. (1997). Photoaging and topical tretinoin: Therapy, Pathogenesis, and Prevention. Arch Dermatol 133(10): 1280-1284. Doi: 10.1001/archderm.1997.03890460104012
  8. Schmidt, N., Gans, E.H. (2011, November). Tretinoin: A Review of Its Anti-inflammatory Properties in the Treatment of Acne. J CLin Aesthet Dermatol 4(11): 22-29. Accessed 2021, May 13, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3225141/
  9. Van Hoogdalem, E.J. (2006). Transdermal absorption of topical anti-acne agents in man; review of clinical pharmacokinetic data. Journal of the European Academy of Dermatology and Venereology 11(1): S13-S19. Doi: 10.1111/j.1468-3083.1998.tb00902.x
  10. Bozzo, P., Chua-Gocheco, A., Einarson, A. (2011). Safety of skin care products during pregnancy. Can Fam Physician 57(6): 665-667.  Accessed online 2021, May 15, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114665/
  11. Del Rosso, J.Q., Pillai, R., Moore, R. (2010). Absence of Degradation of Tretinoin when Benzoyl Peroxide is COmbined with an Optimized Formulation of Tretinoin Gel (0.05%). J Clin Aesthet Dermatol 3(10): 26-28. Accessed 2021, May 15, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958193/
  12. Laquieze, S., Czernielewski, J., Rueda, M.J. (2006). Beneficial effect of a moisturizing cream as an adjunctive treatment to oral isotretinoin or topical tretinoin in the management of acne. Journal of Drugs in Dermatology: JDD 5(10): 985-990. Accessed 2021, May 15, from https://europepmc.org/article/med/17373148
  13. Image by andreas160578 from Pixabay 

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