Tretinoin

Key points

• Tretinoin normalises keratinisation and limits the formation of microcomedones, so pores stay clearer.
• Change is usually visible after 2 to 4 weeks, and treatment is continuous rather than a short course.
• It is contraindicated in pregnancy because of teratogenicity risk, and should not be used by people with eczema, rosacea or sunburn.

What tretinoin is used for

Acne vulgaris is the main use; the prescribing information for RETIN-A covers topical application in the treatment of acne vulgaris. Cream forms are also used for photoageing, where the aim is to improve texture and evenness of tone over time. Both uses sit within a wider skin care routine.

How it works

Tretinoin acts on keratinisation, the process by which skin cells mature and move towards the surface. By normalising it, the medicine prevents microcomedones from forming and speeds up cell turnover, which helps clear pores that are already blocked. In photoageing, the same renewal process is thought to support collagen and soften the look of fine lines. Effects build gradually, typically over 2 to 4 weeks.

Forms and brands

The tretinoin range covers two products: Retin-A Cream in 0.025% and 0.05% strengths, and Retin-A Gel in 0.01% and 0.025%. Both come in tubes. The cream is used for acne vulgaris and photoageing; the gel is used for acne vulgaris. Cream bases suit drier or more sensitive skin, while gels are lighter and suit oilier skin. Orders are prepared by pharmacy partners in India and shipped to Malaysia in discreet packaging.

Safety

Do not use tretinoin if you are hypersensitive to it, or if you have eczema, rosacea or sunburn. It is not for use in children. Pregnancy is a contraindication because of teratogenicity risk, and caution is advised during breastfeeding. Sunlight exposure should be avoided and a sunscreen used, since photosensitivity is a known reaction. Common effects are erythema, peeling and dry skin; severe skin irritation needs immediate medical attention. Benzoyl peroxide and keratolytic agents such as salicylic acid, sulphur and resorcinol interact with tretinoin, and medicated or abrasive cleansers, strong drying products, and those high in alcohol, astringents, spices or lime should be used with caution.

What the sources say

• Treated areas have been reported to become temporarily lighter or darker than the surrounding skin. (DailyMed)
• Hypersensitivity is a rare effect of Treclin gel, seen in at least 1 in 10,000 but fewer than 1 in 1,000 people. (emc)
• Use should stop if a reaction suggesting sensitivity or chemical irritation develops. (DailyMed)
• Contact with the mouth, eyes, mucous membranes and abraded or eczematous skin should be avoided. (emc)

Further reading

• Tretinoin
• Retrieve Cream - NPS MedicineWise
• Tretinoin Topical: MedlinePlus Drug Information
• Tretinoin - StatPearls - NCBI Bookshelf