Tretinoin is the acid form of retinol or vitamin A and is part of the retinoid group. Retinoids have a comedolytic action, which normalizes the follicular epithelium’s desquamation and reduces the follicle’s obstruction, and is an anti-inflammatory action. They also prevent the formation of new microcomedones, so they are helpful as maintenance therapy in those patients who started treatment with combined preparations to reduce the prolonged use of antibiotics.

CLINICAL USE:

Topical treatment of non-inflammatory lesions (comedones) and inflammatory lesions (pustules and papules) in mild to moderate acne vulgaris.

The combination preparation (with clindamycin) is authorized in children >12 years of age ( A ). Available marketed preparations with tretinoin as a monocomponent are not allowed in the pediatric population ( E: off-label ).

DOSAGE AND ADMINISTRATION GUIDELINES:

Topical route

A daily application, preferably at night. Apply a thin layer on the pretentious area and not only on individual lesions with dry skin.

Before application, wash skin with mild soap and water. Let dry without rubbing for 15-30 minutes. After use, wash your hands.

Can notice an initial improvement after 2-4 weeks, and the maximum effect not reached before 6-8 weeks of treatment.

CONTRAINDICATIONS:

  • Hypersensitivity to tretinoin or any of the components of the formulation.
  • Do not apply to skin areas with eczema, abrasions or open or infected wounds.

Prepared in combination with clindamycin:

  • In patients with regional enteritis, ulcerative colitis, or a history of antibiotic-associated colitis.
  • Moreover, in patients with a personal or family history of skin cancer.
  • In patients with a history of acute eczema, rosacea and perioral dermatitis. In patients with deep pustular and nodular-cystic acne varieties (acne conglobata and acne fulminans).

PRECAUTIONS:

  • Tretinoin should not apply together with benzoyl peroxide, as it becomes less stable due to oxidation.
  • Avoid contact with eyes, nasal mucosa or mouth and open wounds, and avoid its accumulation in the corners of the nose.
  • Use caution in patients with eczema or sunburn, where tretinoin can cause severe irritation.
  • The main problem with retinoids is tolerance due to their irritating effect on skin peeling, which means that young people do not well accept them.
  • It is advisable to start with low concentration formulations or with an application every other day or three days to assess tolerance. And vary the concentration or frequency according to the particular response of each patient.
  • Sometimes in the first weeks of treatment can notice an apparent worsening of the acne due to the accelerated disappearance of the microcomedones forming in the deepest part of the skin. This effect is transient and reversible by reducing the frequency of its application or temporarily discontinuing the treatment.
  • Do not abuse facial toners or cosmetic products with a drying or irritating effect. Extreme weather conditions with wind, cold and low humidity can increase skin dryness. Do not use moisturizing creams to counteract peeling.

Exposure to sunlight

Patients should be informed of the importance of sun protection through the use of sunscreens, moisturizing products and appropriate clothing. The treated areas should not be exposed to the sun (even when it is cloudy) or to ultraviolet rays (UVA).

Moreover, treatment with combination antibiotic therapy should not exceed 12 weeks of continuous use without careful evaluation of improvement or persistence of lesions (antibiotic resistance).

SIDE EFFECTS:

The most frequently reported local reactions during treatment are: skin dryness or peeling, burns, itching, burning, severe local erythema, oedema, blisters, eschar, pruritus, and transient hypo- and hyperpigmentation.

The incidence of dry skin in the adolescent population (12-17 years) was slightly higher in clinical trials than in the general population.

These skin reactions were generally mild to moderate, well-tolerated, and resolved after reducing dosage or temporary treatment discontinuation. They usually occurred at the beginning of therapy, except for skin dryness or peeling, which persisted but generally decreased during treatment.

It May cause photosensitivity.