Retin-A, Tretinoin

RETIN-A Retin-A [Tretinoin], Gel, Cream, and Liquid, marketed by OrthoNeutrogena, a division of Ortho-McNeil Pharmaceuticals, Inc is a 3, 7-dimethyl-9-(2, 6, 6-trimethyl-1-cyclohexenyl) -nona-2, 4, 6, 8-tetraenoic acid. Chemically, Retin-A [Tretinoin] is all-trans-retinoic acid. It is used in the treatment of acne vulgaris and keratosis pilaris. Acne vulgaris: Well, almost each and everyone has some other the time in their adolescent suffered from acne vulgaris, commonly called pimples. What is acne exactly? Our skin especially, over the face has a structure called as the pilo-sebaceous unit [skin structures consisting of a hair follicle and its associated sebaceous gland]. It contains the hair follicle and the sebum gland along with its duct. Now, the function of sebum gland is to secrete sebum which then gets expressed on the skin surface. It has got some antibacterial property. Sebum is oily in consistency and if there is increased expression of sebum then it might block the opening of the pilo-sebaceous duct. Due to this there is no drainage from the duct and this leads to the development of comedones. They are initially white, also called as white comedones and later they form black comedones. These comedones eventually lead to the formation of pimples. The most common site is the face though you do get them on the neck, back and chest. Usually associated with dandruff/seborrhic dermatitis but then dandruff is not a causative factor, at least that’s what the doctors have to say till date. People with oily skin are more prone to get acne. Other causes are: - family history - Hormonal activity like menstruation or puberty which is associated with increased levels of hormones. - Stress - Improper diet - Hyperactivity of sebum gland - Bacteria [Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne] - Use of anabolic steroids Why is acne so dreaded? Well the worst part about the acne is that they often leave behind a scar which is very much detested. These scars are more commonly known as blemishes. Adolescent age group is socially very vulnerable and so this [Acne] can be a cause of depression amongst them with a few documented proofs of suicide. However acne is usually self limiting disease and shouldn’t be troublesome after one crosses 25 years of age. It has been documented that newly diagnosed acne patients have low levels of vitamin A in their blood. There is an also decreased level of vitamin E So how do we tackle acne? This can be done in the following ways: • normalizing shedding into the pore to prevent blockage • killing P. acnes • anti-inflammatory effects • hormonal manipulation Though the exact mode of action of Retin-A [Tretinoin] is not known, recent studies suggest that topical Retin-A decreases cohesiveness of follicular epithelial cells with decreased microcomedo formation. Also, tretinoin stimulates mitotic activity and increased turnover of follicular epithelial cells causing extrusion of the comedones. Retin-A brings acne plugs (blockages) to the surface causing blackheads to be dislocated. The blackheads are then discarded from the skin during cleansing. Retin-A can help control acne breakouts as well. Indication: - acne vulgaris - wrinkle removal/anti-ageing - Hyper pigmentation. - Poor Skin Texture: from Retin-A removes dead cells increasing the exfoliation process and thereby stimulating new skin cells to improve the texture of the skin. - Preparation of skin for procedures like laser skin resurfacing and facial surgeries Dosage: Acne vulgaris: 0.1% cream Wrinkle removal: 0.05% cream Application: Acne vulgaris: Retin-A [Tretinoin] is to be applied once daily over the affected areas in the evening, after washing with a mild alcohol-free facial cleanser. Pat the face dry before smoothing the Retin-A [Tretinoin] cream or gel on the skin. Liquid: The liquid is to be applied using a fingertip, cotton swab or a gauze pad. In case a gauze or cotton is being used then care should be taken not to over saturate it, so as to avoid the liquid to run into areas where treatment is not intended. There may be a transient feeling of irritation or warmth on the area of application. If the irritation becomes unbearable then discontinue the product and seek your physician. However there might be an unexpected apparent exacerbation of irritation during the early weeks of therapy and might be most probably due to the potency of the drug or some undetected acne lesion. Ask your physician/doctor to demonstrate on how to apply Retin-A. The doctor will also recommend a daily skincare regimen to reduce the risk of complications and enhance results to guard against increased photosensitivity; you are advised to use sunscreen every morning and throughout the day. Use it for at least 6-7 weeks. Once the lesions start responding to Retin-A, the progress can be maintained by lesser applications. Wrinkle removal: Apply sparingly to the skin's surface until it has been completely absorbed, avoiding the eyes, initially use it 5 times a week, and after that use it for about 3 times a week. Contra-indications: - acute eczema rosacea - cuts - abrasions - acute dermatitis - Eyes, nose, mouth, mucus membrane. In short, the product should be discontinued in case the patient has hypersensitivity to any of its ingredients. Warning: Gels are flammable and one should avoid fire, flame or smoking during its use. Keep out of reach of children. Keep tube tightly closed. Do not expose to heat or store at temperatures above 49°C. Special precautions: - Pregnancy: Pregnancy Category C. Teratogenic effects. - Lactation: It is not known whether this drug is excreted in human milk. Hence better use precaution while using this drug. - Pediatric age group: No conclusive evidence of any safety effectiveness or side effect of Retin-A on children. Hence it is better avoided. - Geriatric age group: Safety and effectiveness in a geriatric population have not been established. - Avoid concomitant therapy with conventional acne, medical or cosmetic products. - Avoid excess exposure to wind or cold since this may irritate the skin while using this medication. - While on Retin-A, use soft soaps and avoid frequent washing and hard scrubbing of the skin since dirt plays a very insignificant role in acne formation. Side – effects/ Adverse Drug Reactions: - dryness of the affected skin - redness, scaling, itching, and burning - increased risk of extreme sunburn [always use a sunscreen or a good pair of shades] - Thinning of the skin: hence avoid doing threading of the skin/hair removal waxing. - Temporary hyper- or hypo pigmentation Samir is the author of Retin-A, Tretinoin information located at site Reference: - Drug Today, July-September 2005 Edition, page 617 - - - - -

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