Topical Tretinoin is available as Gels and Creams in variable strengths for the treatment of mild to moderate acne, fine wrinkles, and damaged skin.

Topical Tretinoin Uses:

• Acne vulgaris:

  • • Altreno, Atralin, Avita, Retin-A, Retin-A Micro, Stieva-A [Canadian product], Tretin-X, and Vitamin-A Acid [Canadian product] are all effective treatments for acne vulgaris.

• Palliation of fine wrinkles, mottled hyperpigmentation, and facial skin roughness:

  • Refissa: When thorough skincare and sun avoidance regimens are unable to provide such palliation, it is utilised as an adjuvant treatment. The appearance of fine wrinkles, splotchy hyperpigmentation, and the tactile roughness of the skin on the face are all diminished (palliated).

• Palliation of fine wrinkles:

  • Renova: It is used in conjunction with complete skincare and sun protection regimens to mitigate (palliate) the appearance of fine wrinkles in patients.

Dose in Adults

Topical Dose for Acne Vulgaris Treatment: 

• Topical: Apply once daily, preferably in the late afternoon or evening, to acne lesions.

Topical Tretinoin Dose for the Relief of Fine Wrinkles (Renova/Refissa), the Treatment of Mottled Hyperpigmentation, and the Treatment of Tactile Roughness of Facial Skin (Refissa):

• Topical: Before going to bed or in the evening, spread a pea-sized dollop of cream over your entire face.

Dose in Children

Topical Tretinoin Dose in the treatment of Acne vulgaris:

• Children over 8 years and Adolescents:

  Topical:

  • Apply once daily to the afflicted areas.
  • Start the treatment with a lesser concentration of tretinoin and increase it as tolerated.
  • Reduce application frequency if stinging or irritation occurs.
  • See each product's label for the specific approved age range.
  • All types and severity of acne in children and teenagers can be treated with topical retinoids, according to recommendations; however, there may not be accurate data available for every formulation of tretinoin product.

• Product-specific Dosage:

  • Atralin (Gel 0.05%):

    • Children over 10 years and Adolescents:
    • Apply once a day to acne lesions before going to bed.

  • Altreno (Lotion 0.05%):

    • Children over 9 years and Adolescents:
      • Apply once daily to the afflicted areas.

• Retin-A (Cream 0.025%, 0.05%, or 0.1%; Gel 0.01% or 0.025%), Tretin-X (Cream 0.025%, 0.0375%, 0.05%, 0.075%, or 0.1%):

  • Children over 12 years and Adolescents:
    • Apply once daily to acne lesions in the evening or just before bed.

• Retin-A Micro:

  • Children 8 to less than 12 years:

  • Topical Gel (0.04%):

    • Apply to acne lesions once a day, preferably before bed or in the evening.

  • Children over 12 years and Adolescents:

  • Topical Gel (0.04%, 0.06%, 0.08%, or 0.1%):

    • Apply once daily to acne lesions in the evening or just before bed.

Oral Treinoin Pregnancy Risk Category: D

Topical Treinoin Pregnancy Risk Category: C

• In several animal reproductive experiments, adverse effects from topical Tretinoin administration were documented.
• After topical application, pregnant women also experienced teratogenic effects; however, no causal relationship has been established.
• Pregnancy acne can be treated with other agents. Avoidance of the first trimester is advised.
• These products shouldn't be used to cure fine wrinkles, uneven pigmentation, roughness in the skin, or to ease a high-risk pregnancy.

Use of topical Tretinoin during breastfeeding

• It is unknown if tretinoin can be found in breast milk after topical application.
• It is an endogenous compound and will likely be found in breast milk.
• The manufacturer suggests caution when giving topical tretinoin to breastfeeding females.
• However, topical treatments are generally preferred to systemic agents for treating acne on the skin in breastfeeding women.
• Topical tretinoin might be safe while breastfeeding, but specific studies are not available.
• To reduce the risk of systemic absorption, it is best to avoid applying large amounts for prolonged periods.
• After applying, mothers should wash their hands.
• Avoid direct skin-to-skin contact with infants who have been treated. Topical agents can transfer to breastfed infants.
• You can consider alternative therapies or postponement.
• If you are using the drug for another purpose, it is best to wait until your baby is fully breastfed before starting treatment.

Topical Tretinoin Dose in Kidney Disease:

No dosage adjustment required.

Topical Tretinoin Dose in Liver disease:

No dosage adjustment required.

Common Side Effects of Topical Tretinoin:

• Local:

  • Local Skin Exfoliation
  • Application Site Pruritus
  • Application Site Burning
  • Application Site Erythema
  • Application Site Irritation
  • Local Desquamation

• Dermatologic:

  • Hypopigmentation
  • Stinging Of The Skin
  • Local Dryness

Less common Side Effects of Topical Tretinoin:

• Local:

  • Application site dermatitis
  • Application site pain

• Dermatologic:

  • Skin Photosensitivity
  • Hyperpigmentation

Contraindications to Topical Tretinoin:

• Hypersensitivity to tretinoin and/or any formulation ingredient
• Notification: The labelling for Atralin or Altreno has no contraindications.
• There is not much evidence of cross-reactivity between retinoids and allergenic retinoids. 
• Cross-sensitivity is possible due to similarities in chemical structure or pharmacologic effects.

Warnings and precautions

• Fish allergies

  • Patients who are sensitive to fish or who have a fish allergy should not use atralin gel since it includes soluble fish protein.

• Hypersensitivity reactions

  • If you have a history of chemical sensitivity, medication sensitivity, or a systemic adverse response, stop using tretinoin.

• Photosensitivity

  • Increased sensitivity to or susceptibility to UV radiation is linked to use.
  • Avoid spending too much time in the sun or a sunlamp.
  • It is advised to use sunscreen every day with an SPF of 15 or higher.
  • Patients should use caution if they have a personal or family history of dermatological cancer.

• Skin irritation:

  • The procedure may make the skin more sensitive to harsh weather, such wind and cold.
  • It is possible to have skin that is too dry, red, or swollen and blistering.
  • Topical medications used concurrently should also be avoided since they might irritate the skin (e.g., medicated or abrasive cleansers, cosmetics with severe drying effects, etc.).
  • You can use a moisturiser or cut down on its use to halt irritation, depending on the intensity and frequency of the irritant.

• Eczema:

  • Use caution when using this product on patients suffering from eczema.

Topical tretinoin (topical all-trans retinoic acid): Drug Interaction

Monitor:

Monitor response to treatment.

How to administer Topical Tretinoin?

• Only for external topical usage
• Not for intravaginal, ophthalmic, or oral use.
• Wash hands and face lightly with gentle soap before applying.
• Wait for 20 to 30 minutes after drying off.
• Apply a little coating to the afflicted region in the evening or right before bed, keeping your lips, ears, nose, and eyes out of the way.
• Reduce the frequency of application or temporarily stop using it if stinging or irritation occurs.
• After using, wash your hands right away.
• Avoid using items in the afflicted region that have strong alcohol, astringent, or spice concentrations.
• Sunburned skin shouldn't be applied.
• If you need combined topical therapy, you might want to think about splitting the administrations 
• Avoid touching the application area and the lime peel when using Retin-A Micro.

Mechanism of action of Topical Tretinoin:

• It's a derivative of vitamin A.
• It can be applied topically to modify epithelial growth or differentiation.
• Patients with acne have follicular epithelial cells that are less cohesive, which can inhibit the development of micro-comedones.
• Tretinoin also promotes the mitotic process, accelerates the turnover of follicular epithelial cells, and causes comedones to extrude.

The onset of action:

• Acne: 2 weeks, although it might take 7.
• Wrinkles on the face: up to six months

Metabolism:

• Hepatic; forms metabolites

Absorption: Minimal Bioavailability:

• Avita cream and gel:       <0.3%;
• Retin A Micro 0.1% gel:     ~1%

Excretion:

• Urine and feces

International Brands of Topical Tretinoin:

• Avita
• Renova Pump
• Retin-A Micro Pump
• Tretin-X
• Altreno
• Atralin
• Retin-A
• Retin-A Micro
• Stieva-A
• A-Acido
• Aberela
• Acetretin
• Acfen-A
• Acid A Vit
• Acnatac
• Acne-Free
• Acnederm
• Acnetin-A
• Acretin
• Airol
• Alten
• Refissa
• Renova
• Avitcid
• Betarretin
• Cordes VAS
• Cosmotrin
• Curacne
• Derm A
• Effederm
• Eudyna
• Idaman
• Ketrel
• Retin-A
• Retin-A Micro
• Li Ling
• Locacid
• Melavita
• Neocare
• Nilac
• Optimal Gel
• Renova
• Retacnyl
• Retavit
• Retico
• Reticrem
• Retigel
• Retin A
• Retin-A
• Retino-A
• Retinova
• Retirides
• Retrieve
• Retrieve Cream
• Reviderm
• Roaccutane
• Smooderm
• Stieva-A
• Stieva-A Forte
• T3 Actin
• T3Actin
• Tracne
• Tracnesan
• Trena
• Trentin
• Tretin-A
• Trinon

Topical Tretinoin Brand Names in Pakistan: