Vol.1, No.8

What is tretinoin and does it work?

Tretinoin is a safe and effective topical treatment premature aging of the skin. Tretinoin has been proven to improved mild sun damage, fine wrinkles and discoloration if used as part of with a comprehensive skin care program.

Skin care products
Photo Credit: Diane Diederich
Looking and feeling young have always been important to most people. As the median age of our population rises, more and more people are searching for safe and effective ways to reduce the signs of aging. Over the past ten years, many new techniques for combating the signs of aging have become available. Print and broadcast media inundated consumers with advertising about quick and easy cures for aging skin that promise dramatic results overnight. How can you decide what treatment is the best for you?

First, let's look at how and why skin ages. Skin becomes thinner and less able to hold moisture over time. Elasticity decreases as collagen and elastin are damaged by time and sunlight. Skin becomes hyperpigmented. Facial muscles atrophy and become somewhat contracted, contributing to wrinkles. Some of the major causes of premature skin aging are excessive sun exposure, smoking, poor nutrition and lack of skin care.

Topical medications, Botox, laser resurfacing, dermabrasion and chemical peels are some of the more common techniques offered to reduce skin damage associated with aging. Botox works to temporarily paralyze the small smooth muscles of the face. Injections cost about $400-500. A couple of injections are usually needed. Results last about six months. Chemical peels use acids to destroy the uppermost layer of damaged skin and expose the fresher deep layers. They cab cost between $1000-2000 per treatment. Dermabrasion is a mechanical method of removing the topical damaged skin. The average cost is about $1400. Many of these procedures are costly, painful and have some associated risks.

Use of topical medications can be a less invasive, low risk treatment for sun damaged skin. Tretinoin is topical medication commonly known as Retin-A. The FDA approved tretinoin 1971 for the treatment of acne vulgaris (severe cystic acne).

Tretinoin is a derivative of vitamin A. It works to alter the skin cells by modulating gene expression, rather than inducing cell necrosis (death). The effect of tretinoin is the speeding of skin cell turnover, reducing breakouts and producing smoother, younger looking skin. Melanocytes, the skin cells responsible for skin pigment, are suppressed by tretinoin. This decreases skin discoloration and uneven skin tone. As a result, fine lines and wrinkles are reduced, skin feels smoother and looks more evenly colored.

While many people know Retin-A for its effectiveness in the treatment of severe acne, other uses have been found. It is important to understand what this medication can and cannot do for your skin. Tretinoin cannot reverse severe skin damage, wrinkling or advanced sun damage.

Tretinoin is a prescription medication, which requires an order from your physician. It is marketed by various of pharmaceutical companies as Altinac™; Avita®; RENOVA®; Retin-A™; Retin-A® Micro. Use tretinoin exactly as prescribed by your doctor. The usual regimen is once daily application of a thin film to the face prior to bedtime. Make sure to avoid sensitive skin on the lips and under the eye area. For more sensitive skin, your doctor may recommend every other or every third day application.

Application of more than the recommended amount will not provide faster or better results. Overuse is likely to cause more skin irritation. Gel preparation of this medication seems to give better results as it can penetrate the skin more. While undergoing a skin regime using tretinoin, you can wear make up, but be sure to clean your face thoroughly before using your medication.

Initially, tretinoin frequently causes more breakouts. About 50% of users report some skin irritation or increase in symptoms. Most patients experience a quick resolution of any adverse, usually within seven days. Very few users report side effects significant enough to cause them to discontinue the treatment. If skin irritation is bothersome, apply the medication less frequently unit your skin adapts. Benzoyl peroxide neutralizes the effects of tretinoin, so discuss concurrent use with your doctor.

The FDA has not approved this drug for use in pregnant women. Safe and effective use has not been documented in patients under 21.

Possible side effects

Burning, peeling, and skin redness are common side effects of tretinoin use. This transient skin irritation which usually reverses quickly as your skin becomes accustomed to the medication. If prolonged irritation, blistering or peeling occur, consult your doctor immediately.

Using this medication will make your skin much more sun-sensitive. If you are exposed to excessive sunlight, your skin will be more quickly and severely sunburned. So make sure to use sunscreen, wear a hat and avoid excessive sun exposure. Other medications including isotretinoin, amiodarone, tetracycline or quinolone antibiotics, sulfa-drugs or phenothiazines increase sun sensitivity also, so if you are using any of these it is very important to let your doctor know, as the effects are cumulative.

Does tretinoin really work?

Numerous clinical studies have proven tretinoin to reduce signs of photoaging including hyperpigmentation, fine lines, and surface roughness. What is important to know is that the most noticeable results occurred when tretinoin was combined with a consistent skin care program, including protection from sun exposure. All clinical studies show that the results of tretinoin use without a consistent skin care program were markedly less dramatic. Your doctor should recommend a comprehensive skin care program including UV protection to be used in conjunction with tretinoin.

Are results long lasting?

Several of the studies on tretinoin confirm that maximum improvement of the skin is seen after about 24 weeks of use. Longer treatment does not seem to yield increased benefits. No studies have been done to examine the long term effects of tretinoin. The safety profile of tretinoin suggests there are no significant adverse effects of using tretinoin for long periods of time. To maintain the beneficial effect on the skin, a maintenance regimen is required. If treatment is discontinued, benefits will fade.

How is tretinoin different from over the counter preparations?

Topical creams available over the counter (with a doctor's prescription) may contain derivatives of tretinoin. However, these are not in the concentrations used in clinical trials which showed measurable benefits. Non-prescription preparatin are also not subject to government (FDA) regulation. The accuracy of the ingeredients, concentrations and product cinsistencyin unregulated "cosmeceuticals" is not verified by any agency. No one can really be sure of their effectiveness.

Tretinoin available by prescription ranges from a concentration of 0.025% to 0.1% in cream vehicle. Gel vehicle which pentrates the skin better is available in concentrations of 0.01% to .025%. Tretinoin preparations cost between $60-$115 for a 40g tube. Typically, this should last for 4-6 months of treatment. Renova (Ortho Biotech Inc) costs $115 40g tube or $135 for 60g tube. Generic tretinoin (Spear) costs $75 for a 20g tube. Other manufactures offer comparable products at similar costs.

Information presented in this article was compiled from The American Society for Dermatologic Surgery, The American Society for Plastic Surgeons and and Pepid, Portable Information System for Physicians. For further information, consult your Board Certified dermatologist or plastic surgeon.

If you decide you want to investigate improving your appearance and skin, consult your dermatologist or cosmetic surgeon to learn more about your options. Information presented in this article is designed to help you gather information about your skin care options and make the most appropriate choice for your skin.