Tretinoin

Topical Retinoid

Tretinoin is available as a prescription topical treatment. It is available in cream, gel, and lotion forms. 

  • Available forms:

    • Topical treatment: 

      • Cream:
        Available as prescription
        • Brand names (US):
          • Avita®
          • Refissa®
          • Renova®
          • Retin-A®
          • Tretin-X®
            Generic available (US)
      • Gel: 
        Available as prescription
        • Brand name (US):
          • Atralin®
          • Avita®
          • Retin-A®
          • Retin-A Micro®
            Generic available (US)
      • Lotion: 
        Available as prescription
        • Brand name (US):
          • Altreno®
            Generic available (US)
  • Available in these doses:

    • Cream: 0.02%, 0.025%, 0.0375%, 0.05%, 0.1%
    • Gel: 0.01%, 0.025%, 0.04%, 0.05%, 0.06%, 0.08%, 0.1%
    • Lotion: 0.05%
  • Who is it for? 

    • Gender:
      • Males and females
    • Severity of acne:
      • Mild-to-moderate acne
    • Age:
      • Children of 9 years and older (Altreno®), Children of 10 years and older (Atralin®), children of 12 years and older (Retin-A®), Retin-A Micro®, Tretin-X®), adolescents, and adults
    • Other:
      • It is also prescribed to treat fine wrinkles (Refissa / Renova®), mottled hyperpigmentation (Refissa®), and rough facial skin (Refissa®)

How to use it:

Tretinoin is a topical treatment and is available as a cream, gel, and lotion for the treatment of acne. 

Tretinoin is usually applied once a day around bedtime, or once every two or three days. 

When you first start using tretinoin, your acne may initially seem to worsen over the first 7 to 10 days. You may also experience red, scaling skin. Visible improvement in acne is usually seen after 2 to 3 weeks of treatment and sometimes not until after 6 weeks of continued use. Applying a larger quantity of tretinoin will not speed up the healing process. 

The amount and frequency of application may vary between individuals. Your physician will specify how much of the medication you need to apply and how often. Your physician may adjust the dose and frequency of the treatment, or even temporarily stop treatment, depending on the improvement of your acne and the side-effects you experience.

Keep regular appointments with your physician so that your response to the treatment may be monitored.

Tretinoin should only be applied to intact skin. If the skin is scraped, irritated, or sunburned, do not apply tretinoin until the skin has healed completely. If tretinoin gets into a cut or scrape, rinse it off with water. 

Do not use any other topical medication when using tretinoin, unless your physician advises otherwise, especially benzoyl peroxide, salicylic acid, or dandruff shampoos containing sulfur or resorcinol. 

Do not get tretinoin in your eyes, nose, or mouth. If it does get into your eyes, wash your eyes with a generous amount of water and seek medical attention immediately if there is any persisting irritation. 

Follow the instructions on your prescription carefully and use tretinoin exactly as prescribed by your physician. Do not change the dose or the frequency of your medication because this may cause skin irritation. If you have any questions about the medication or the prescription, ask your physician or pharmacist. 

Cream, gel, lotion:

  • Before applying tretinoin, wash your hands and wash the acne-affected skin with water and a mild cleanser. Rinse the skin and pat dry with a soft towel. You can ask your physician to recommend a gentle cleanser. 
  • Wait at least 20 to 30 minutes after washing your skin before applying tretinoin.
  • Apply a thin layer of tretinoin on acne-affected areas using your fingertips or a sterile gauze pad or cotton swab.
  • Do not use bandages, dressings, or wrappings to cover the affected area.
  • Once you have finished applying the medication, wash your hands with soap and water. 

Be aware of: 

  • Before using tretinoin, let your physician or pharmacist know if you are allergic to tretinoin or to any of the other ingredients in the cream, gel or lotion. 
  • Before using tretinoin, inform you physician about the prescription and non-prescription medications, vitamins, nutritional supplements, and herbal products you are using/taking. 
  • If you are using tretinoin and are pregnant or are planning on becoming pregnant, talk to your physician about using tretinoin during pregnancy.
  • If you are using tretinoin and are breastfeeding, talk to your physician about using tretinoin during this period.
  • Tretinoin may make your skin more sensitive to sunlight so avoid unnecessary direct or prolonged exposure to sunlight, and wear protective clothing, sunglasses, and sunscreen (with an SPF of at least 15) while using tretinoin. 
  • Before using tretinoin, inform your physician about the the skin and hair care products you use, including soaps, shampoos, cleansers, moisturizers, and cosmetics. Certain products may irritate the skin if used with tretinoin, especially products that are harsh, dry the skin, or contain alcohol, spices, or lime rind. Ask your physician to recommend products that do not irritate the skin. 
  • If tretinoin was prescribed for acne, you can continue your regular diet unless your physician advises otherwise.
  • Do not use tretinoin for a skin condition that it was not prescribed for, without consulting your physician first. 
  • Do not share your medication with anyone else. 
  • Keep your regular appointments with your physician to track your response to tretinoin.

Drug interactions: 

Do not use alcohol-, menthol-, spices-, or lime-containing skin care products while using tretinoin. Inform your physician or pharmacist about all the prescription and non-prescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take before starting tretinoin. Also inform your physician or pharmacist of any skin products you use including soaps, cleansers, moisturizers, and cosmetics. 

Do not swallow

If tretinoin is swallowed, contact an emergency facility or call the American Association of Poison Control Centers at 1 (800) 222-1222 (available 24/7).

If immediate assistance is necessary because the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, call 911.

Information can also be found online at https://www.poisonhelp.org/help

What if I miss a dose?

If you are using tretinoin daily, skip the missed dose. Do not apply tretinoin more than once a day. If you are using tretinoin every 2 or 3 days, apply the missed dose immediately if this is within 12 hours of the time that you usually apply tretinoin. Otherwise, skip the missed dose and continue with your prescribed dosing schedule.

Do not increase the quantity or frequency of application to make up for the missed dose.

Storage:

Store your medication in the container that the pharmacist provided and keep it out of reach and out of sight of children. Many containers can be opened by children. Keep the container tightly closed. Always lock safety caps and immediately place the medication in a safe location that is up and away from the sight of young children, to prevent poisoning (www.upandaway.org).

Store the medication at room temperature. Keep the medication away from excessive heat and moisture – do not store in the bathroom. Do not freeze tretinoin.

Disposal:

Do not keep outdated medication and medication that you no longer use. Unneeded medications should be disposed of in a way that pets, children, and other people cannot consume them. Do not flush the medication down the toilet. Contact your pharmacist to learn about the availability of a medicine take-back program in your neighborhood, or get in touch with your local garbage/recycling department to ensure safe disposal. If you do not have access to a take-back program, you can find more information on safe disposal of medication on the FDA website: (https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm)

References
  1. Medlineplus.gov. (2019). Tretinoin: MedlinePlus Drug Information. [online] Available at: https://medlineplus.gov/druginfo/meds/a682437.html.  [Accessed 30 January 2019].
  2. Toxnet.nlm.nih.gov. (2019). Tretinoin. [online] Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~pGdDGB:1.  [Accessed 30 January 2019].
  3. Uptodate.com. (2019). Tretinoin. [online] Available at: https://www-uptodate-com.eresources.mssm.edu/contents/topical-tretinoin-topical-all-trans-retinoic-acid-drug-information?search=tretinoin&source=search_result&selectedTitle=2~104&usage_type=default&display_rank=1.  [Accessed 30 January 2018].
  4. Epocrates.com. (2019). Tretinoin. [online] Available at:https://online.epocrates.com/drugs/296/tretinoin-topical. [Accessed 30 January 2018]