tretinoin (topical)

Contraindicated in:

Hypersensitivity to tretinoin, fish (Altreno only), or any components in the formulation;
Known alcohol intolerance (gel only);
OB: Pregnancy.

Use Cautiously in:

Areas around the mouth, eyes, angles of the nose, or other mucous membranes;
Patients ≥50 yr, with a history of skin cancer or with moderately pigmented skin or for >48 wk (safety and effectiveness not established);
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children <12 yr (Retin-A, Retin-A Micro), <10 yr (Atralin), or <9 yr (Altreno).

Adv. Reactions/Side Effects ⬆ ⬇

Derm: photosensitivity, redness, blistering, edema, crusting, hyperpigmentation, hypopigmentation

Interactions ⬆ ⬇

Drug-drug:

Concurrent use with keratolytic agents (benzoyl peroxide, salicylic acid, sulfur, or resorcinol) ↑ risk of excessive skin irritation.
↑risk of photosensitivity with other photosensitizing agents.
Risk of irritation ↑ by other topical skin-care products (aftershave, cover-up, make-up, perfumes, colognes).
↑absorption of topical minoxidil.

Availability ⬆ ⬇

(Generic available)

Cream: 0.02%; 0.025%; 0.05%; 0.1%
Gel: 0.01%; 0.025%; 0.04%; 0.05%; 0.06%; 0.08%; 0.1%
Lotion: 0.05%
In combination with: clindamycin (Ziana); hydroquinone and fluocinolone (Tri–Luma). See Appendix [not included in this PDA edition]).

Route/Dosage ⬆ ⬇

Acne

(Adults and Children ≥12 yr [Retin-A or Retin-A Micro], ≥10 yr [Atralin], or ≥9 yr [Altreno]): Apply once daily (Retin-A, Retin-A Micro, and Atralin should be administered before bedtime).

Photoaging

(Adults ): Renova—Apply a thin film once daily at bedtime; if irritation occurs, lower concentration or less frequent application may be tried.

US Brand Names ⬆ ⬇

Altreno, Atralin, Avita, Renova, Retin-A, Retin-A Micro

Action ⬆ ⬇

Decreases the formation of microcomedones and stimulates turnover of follicular epithelium.

Therapeutic effects:

Decreased acne formation with improved skin appearance.
Decreased skin roughness, hyperpigmentation, and wrinkling due to photoaging.

Classifications ⬆ ⬇

Therapeutic Classification: antiacne agents

Pharmacologic Classification: retinoids

Pharmacokinetics ⬆ ⬇

Absorption: Minimal systemic absorption occurs with limited surface-area application.

Distribution: Unknown.

Metabolism/Excretion: <5% of dose applied to skin is excreted in urine.

Half-Life: Unknown.

Canadian Brand Names ⬆ ⬇

Time/Action Profile ⬆ ⬇

(improved skin appearance)

ROUTE	ONSET	PEAK	DURATION
Topical (acne)	2–3 wk	6 wk	unknown
Topical (photoaging)	within 24 wk	unknown	2 mo‡

‡Following discontinuation.

Patient/Family Teaching ⬆ ⬇

Instruct patient to apply tretinoin as directed. Application may cause a transient feeling of warmth and a slight stinging. Avoid application near eyes, mouth, angle of the nose, and mucous membranes. Do not apply excessive amounts, because this may cause redness, peeling, or discomfort and will not improve results. If a dose is missed, omit and apply next dose at regularly scheduled time; do not double doses. Advise patient to read Patient Information before starting therapy and with each Rx refill in case of changes.
Explain to patient that a temporary worsening of acne may occur at beginning of therapy.
Advise patient to consult with health care professional before using other acne preparations while using tretinoin. Normal use of cosmetics is permissible, but area to be treated must be thoroughly cleansed prior to application. Medicated or abrasive soaps or cleansers, soaps and cosmetics that have a strong drying effect, and products that have a high concentration of alcohol, astringents, spices, or lime also may worsen dry skin.
Caution patient to use sunscreens with an SPF of at least 15, and protective clothing to prevent photosensitivity reactions. Consult health care professional about sunscreen; some sunscreens may worsen acne. Patients should be taught to minimize exposure to sunlight and sunlamps, and if sunburned to cease tretinoin treatment until fully recovered. Other weather extremes (wind, cold) also may be irritating to skin.
Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇