Dr. Thomas P. Habif, MD discusses Acne Treatment with Topical Retinoids Retin-A. See more at http://www.dermnet.com PLEASE RATE AND COMMENT!!!
Topical retinoids are the foundation for the treatment of acne. They

are effective for comedonal and inflammatory acne.

Mechanism of action

Retinoids normalize keratinization.

They increase the turnover of

follicular epithelial cells, corneocytes are shed at an accelerated

rate and comedones are extruded. New comedone formation is inhibited.

Retinoid

Formulation

The choice of vehicle is important. Creams are used for dry sensitive

skin, gels are for patients with oily skin. Tretinoin was the first

retinoid. It may cause

irritation and improvement may not occur for 1-3

months. Tretinoin is not stable in sunlight.

Tretinoin (Retin-A and generics)

Cream: 0.025%, 0.05%, 0.1%

Gel: 0.01%, 0.025%

Solution: 0.05%

Tretinoin in other vehicles

Microsphere vehicle (Retin-A Micro): 0.04% gel, 0.1% gel

Adapalene is a derivative of tretinoin. It is stable in sunlight and

resistant to oxidation by benzoyl peroxide. Adapalene has a low

irritation potential and no phototoxicity.

Third-generation topical retinoids

Adapalene (Differin): 0.1% gel,

0.1% solution, 0.1% pledgets, 0.1% cream

Tazarotene is a synthetic retinoid that is effective for acne and

psoriasis. Tretinoin and adapalene are category C drugs, and

tazarotene is a Category X drug. This difference in categorization by the FDA is based on the use of tazarotene in the treatment of psoriasis

Third-generation topical retinoids

Tazarotene (Tazorac): 0.1% cream, 0.1% gel

where medication is used over a wide area.

The newer topical retinoids have an antiinflammatory effect and are

first-line treatment

for both comedonal and inflammatory acne. Topical

retinoids are used for maintenance therapy to prevent the formation of

new microcomedones. Topical retinoids are often used

in combination

therapy, especially with benzoyl peroxide and topical and/or oral

antibiotics.

Patient instruction of use of topical retinoids

Proper use and application is the

key to success and avoiding

irritation. It is not necessary to produce irritation to obtain

efficacy. Patients who are irritated will be noncompliant. Wash the

face with a

mild cleanser. A Soapless cleanser such as Cetaphil can be used for patients with very sensitive skin. Avoid wash cloths or

abrasive cleansers. Wait for 20 minutes so that the

skin becomes dry.

Application of medication to wet skin enhances penetration and

irritation. Apply just enough medication to cover the skin.

Acne may be worse in the first few

weeks as microcomedones and

comedones are extruded.

Consider starting with every other day application until daily

application can be tolerated. Another technique is to apply

the

retinoid in a “”short-contact”" manner. Apply medication for 30 seconds

to 5 minutes then wash off the drug. This can be done once or twice

each day to help the skin to

adapt.

Patient instructions

- Wash face gently with a mild cleanser

- Wait 20 minutes after washing before application

- Apply a very thin layer of medication.

- Use noncomedogenic

moisturizers to control irritation

- Avoid excessive sun exposure

- Apply a sunscreen daily

- Protect the face from cold and wind

Several studies have compared these agents.

Tazarotene gel 0.1 is more effective than tretinoin gel 0.025 and the

microsphere gel. The reduction of open comedones at 12 weeks was 65% for tazarotene vs 44% for tretinoin.

Adapalene gel 0.1% is as effective as tretinoin gel microsphere 0.1%

after 12 weeks of treatment, but tretinoin gel achieved a greater

reduction in the number of comedones at

week 4.

Alternate-day applications of tazarotene 0.1% gel and daily

applications of adapalene 0.1% gel give similar results at 15 weeks.

The response to tazarotene treatment

was greater during the first 3-6

weeks of treatment.

Tazarotene plus clindamycin lotion is more effective than either agent

used alone. Tazarotene in combination with benzoyl

peroxide or an

erythromycin/benzoyl peroxide gel is as effective as tazarotene used

as monotherapy.

Duration : 0:5:5

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