all-trans retinoic acid; tretinoin (Retin-A, Renova, Avita, Altreno, ATRA)
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Introduction
Topical agent: Tradename: Retin-A, Avita. Systemic agent: ATRA.
Indications
- acne vulgaris
- palliative care for skin aging
- improve signs of photodamage (dermatoheliosis)
- most effective on non-sun-exposed areas[5]
- treatment of promyelocytic leukemia
- alone or in combination with anthracyclines
- verruca plana
- lamellar ichthyosis
- Darier-White disease
Contraindications
- prevention of non-melanoma skin cancers[8]
- pregnancy category D (oral)[4]
- pregnancy category C (topical)[4]*
* ref[4] adds that anticipated benefit should clearly outweigh any potential risk & that most dermatologists avoid using topical retinoids during pregnancy
Dosage
- topical: apply QHS. Packaging:
- Retin-A for acne
- Renova for wrinkles
- cream 0.05%
- Avita 0.025% gel or cream
- Altreno (lotion 0.05%)[9]
Adverse effects
- not common (1-10%)
- edema, excessive dryness, erythema, scaling of skin, hyperpigmentation, hypopigmentation, stinging, blistering, photosensitivity
- other
- local inflammation
- teratogenic - avoid during pregnancy & nursing
- topical use associated with increased risk of mortality in elderly[7]
- all-trans-retinoic acid-induced differentiation syndrome[4]
- neutrophilic dermatosis
Mechanism of action
- inhibition of keratinization
- sloughing of horny cells
- may enhance repair of UV damage
- promotes cellular differentiation
- thickens epidermis & rete ridges
More general terms
Component of
- all trans retinoic acid/cortisol
- all trans retinoic acid/betamethasone/hydroquinone
- all trans retinoic acid/benzoyl peroxide
- all trans retinoic acid/clindamycin/phosphate
- all trans retinoic acid/mequinol
- all trans retinoic acid/fluocinolone/hydroquinone
- all trans retinoic acid/clindamycin
- benzoyl peroxide/tretinoin (Benzashave)
- mequinol/tretinoin (Solage)
References
- ↑ The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- ↑ Drug Information & Medication Formulary, Veterans Affairs, Central California Health Care System, 1st ed., Ravnan et al eds, 1998
- ↑ Kaiser Permanente Northern California Regional Drug Formulary, 1998
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17. American College of Physicians, Philadelphia 1998, 2012, 2015.
- ↑ 5.0 5.1 UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ Department of Veterans Affairs, VA National Formulary
- ↑ 7.0 7.1 Weinstock MA et al Topical tretinoin therapy and all-cause mortality. Arch Dermatol 2009 Jan; 145:18. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19153339
Schilling LM and Dellavalle RP Dealing with unanticipated mortality in a large randomized clinical trial of topical tretinoin. Arch Dermatol 2009 Jan; 145:76 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19153348 - ↑ 8.0 8.1 Weinstock MA et al. Tretinoin and the prevention of keratinocyte carcinoma (basal and squamous cell carcinoma of the skin): A Veterans Affairs randomized chemoprevention trial. J Invest Dermatol 2012 Jun; 132:1583 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22318383
- ↑ 9.0 9.1 Brooks M FDA Clears First Tretinoin Lotion for Acne (Altreno) Medscape - Aug 27, 2018. https://www.medscape.com/viewarticle/901240