Tretinoin is a topical retinoid. Retin-A is used in the treatment of acne vulgaris. It normalizes desquamation of the follicular epithelium, promotes drainage of preexisting comedones, and prevents the formation of new comedones.
Tretinoin has proven to be beneficial for skin damaged by the sun and also by natural ageing. Tretinoin helps to reduce fine facial wrinkles, splotchy pigmentation, and rough skin texture. Renova cream 0.02% and 0.05% are the only formulations of tretinoin approved by the FDA for the treatment of visible signs of ageing. Other forms of tretinoin are indicated for acne only.
Topical tretinoin noticeably improves hypertrophic scars, keloids, and acne scars.
When to expect the results?
Improvement in acne is apparent after 2–3 weeks. Optimal results may require more than 6 weeks.
Softening and smoothness of the skin are the first improvements to be noticed. This is achieved due to compaction of the stratum corneum, epidermal thickening, and increased production of hyaluronic acid.
The improvement in wrinkling is a later benefit, seen after 3-4 months of tretinoin application. Tretinoin prevents dermal collagen breakdown and stimulates synthesis of new collagen. It can also safeguard against UV collagen destruction and thus prevent photodamage.
How long to use tretinoin for wrinkles? Tretinoin is safe and effective for long-term (up to 2 years) treatment .
The disappearance of mottled hyperpigmentation takes 1 year to become noticeable.
Retin-A vs Adapalene (Differin)
Adapalene 0.1% gel may reduce acne lesion counts more rapidly than tretinoin 0.025% gel. However, after 3 months of application both retinoids bring similar benefits. Adapalene produces less intense skin irritation than tretinoin.
Retin-A vs Tazarotene (Tazorac)
Tazarotene has greater comedolytic activity compared to other topical retinoids. The results of clinical study showed better efficacy of tazarotene in the treatment of acne. The reduction of open comedones at 12 weeks was 65% for tazarotene vs 44% for tretinoin. Tazarotene was also superior in the reduction of non-inflammatory lesions at 12 weeks (55% vs 42% for tretinoin).
Tazarotene cream is slightly better than tretinoin emollient cream (Renova) in improving photodamaged facial skin. Tazarotene provides more rapid improvement in skin appearance, particularly for fine wrinkling and hyperpigmentation.
Retin-A versus Retin-a Micro
While both formulations contain tretinoin (a natural form of vitamin A), the Retin-A Micro offers the advanced microsphere technology to reduce irritation and the appearance of facial shine.
Retin-A Micro uses patented methyl methacrylate/glycol dimethacrylate crosspolymer porous microspheres (Microsponge® System) to enable inclusion of the active ingredient, tretinoin, in an aqueous gel.
What is better: Retin A cream or gel?
In general, tretinoin gel formulation is stronger than cream because the medicine penetrates better when it is in a gel form.
If prolonged sun exposure is expected, such as a vacation, discontinue use of the retinoid 1 week before the exposure and resume upon return.
It is recommended to apply tretinoin to the entire face on a nightly basis. By applying to the entire face, efficacy can be enhanced, as the active ingredient works where it is placed. Spot treating should be avoided because this can lead to a blotchy appearance of the skin. Application should extend to the hairline and feather down along the jaw line. Mucous membranes, corners of the nose, mouth, and eyes should be avoided. Tretinoin can be applied to upper and lower eyelids, if addressing photodamage.
If bothersome irritation, pruritus, or peeling occurs, you may break 1 to 2 nights off of the tretinoin. Moisturize during the break and then resume the retinoid only with a sunscreen. Do not miss more than 2 days, to minimize the duration of the irritation phase. You may decrease the frequency of application when treating areas such as the eyelids, neck, torso, or extremities to 2 to 3 times a week. Sometimes, decreasing the frequency to every other day or even 3 times a week can be helpful. The strength of tretinoin can also be temporarily decreased.
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