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Generic name: Tretinoin
Tretinoin (TRET-i-noyn) is used to treat acne. It works partly by keeping skin pores clear.
One of the tretinoin creams is used to treat fine wrinkles, dark spots, or rough skin on the face caused by damaging rays of the sun. It works by lightening the skin, replacing older skin with newer skin, and by slowing down the way the body removes skin cells that may have been harmed by the sun. Tretinoin works best when used within a skin care program that includes protecting the treated skin from the sun. However, it does not completely or permanently erase these skin problems or greatly improve more obvious changes in the skin, such as deep wrinkles caused by sun or the natural aging process.
Tretinoin may also be used to treat other skin diseases as determined by your doctor.
Tretinoin is available only with your doctor's prescription, in the following dosage forms:
- Cream (U.S. and Canada)
- Gel (U.S. and Canada)
- Topical solution (U.S. and Canada)
Before Using This Medicine
In deciding to use a medicine, the risks of using the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For tretinoin, the following should be considered:
Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to acitretin, etretinate, isotretinoin, tretinoin, or vitamin A preparations. Also tell your health care professional if you are allergic to any other substances, such as preservatives or dyes.
Pregnancy—Tretinoin has not been studied in pregnant women. Topical tretinoin is not recommended during pregnancy. Topical tretinoin has been shown to cause delayed bone development in some animal fetuses. Before using this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.
Breast-feeding—It is not known whether tretinoin passes into the breast milk. Mothers who are using this medicine and who wish to breast-feed should discuss this with their doctors.
Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of this medicine in children with use in other age groups. Children are unlikely to have skin problems due to the sun. In older children treated for acne, tretinoin is not expected to cause different side effects or problems than it does in other age groups.
Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of tretinoin in patients 50 years of age and older with use in other age groups.
Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your health care professional if you are using any other topical prescription or nonprescription (over-the-counter [OTC]) medicine that is to be applied to the same area of the skin. When you are using topical tretinoin, it is especially important that your health care professional know if you are taking any of the following:
- Acitretin (e.g., Soriatane)
- Etretinate (e.g., Tegison)
- Tretinoin, oral (e.g., Vesanoid)—May increase chance of getting severe dryness or redness of skinOther medical problems—The presence of other medical problems may affect the use of tretinoin. Make sure you tell your doctor if you have any other medical problems, especially:
- Dermatitis, seborrheic or
- Eczema or
- Sunburn—Use of this medicine may cause or increase the irritation associated with these problems
Proper Use of This Medicine
It is very important that you use this medicine only as directed. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause irritation of the skin.
Do not apply this medicine to windburned or sunburned skin or on open wounds.
Do not use this medicine in or around the eyes or lips, or inside of the nose. Spread the medicine away from these areas when applying. If the medicine accidentally gets on these areas, wash with water at once.
This medicine usually comes with patient directions. Read them carefully before using the medicine.
Before applying tretinoin, wash the skin with a mild soap or cleanser and warm water by using the tips of your fingers. Then gently pat dry. Do not scrub your face with a sponge or washcloth. Wait 20 to 30 minutes before applying this medicine to make sure the skin is completely dry. Applying tretinoin to wet skin can irritate the skin.
To use the cream or gel form of this medicine:
- Apply just enough medicine to very lightly cover the affected areas, and rub in gently but well. A pea-sized amount is enough to cover the whole face.
To use the solution form of this medicine:
- Using your fingertips, a gauze pad, or a cotton swab, apply enough tretinoin solution to cover the affected areas. If you use a gauze pad or a cotton swab for applying the medicine, avoid getting it too wet. This will help prevent the medicine from running into areas not intended for treatment.
After applying the medicine, wash your hands to remove any medicine that might remain on them.
The dose of topical tretinoin will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average dose of topical tretinoin. If your dose is different, do not change it unless your doctor tells you to do so.
- For topical dosage forms (cream, gel, or solution):
- For acne:
- Adults and teenagers—Apply to the affected area(s) of the skin once a day, at bedtime.
- For cream dosage form (brand name Renova only):
- For fine wrinkles, dark spots, or rough skin caused by the sun:
- Adults up to 50 years of age—Apply to the affected area(s) of the skin once a day, at bedtime.
- Adults 50 years of age and older—Use and dose must be determined by your doctor.
If you miss a dose of this medicine, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
To store this medicine:
- Keep out of the reach of children.
- Store away from heat and direct light. The gel product is flammable and should be kept away from fire or excessive heat.
- Keep the medicine from freezing.
- Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.
Precautions While Using This Medicine
During the first 3 weeks you are using tretinoin, your skin may become irritated. Also, your acne may seem to get worse before it gets better. It may take longer than 12 weeks before you notice full improvement of your acne, even if you use the medicine every day. Check with your health care professional at any time skin irritation becomes severe or if your acne does not improve within 8 to 12 weeks.
You should avoid washing the skin treated with tretinoin for at least 1 hour after applying it.
Avoid using any topical medicine on the same area within 1 hour before or after using tretinoin. Otherwise, tretinoin may not work properly or skin irritation might occur.
Unless your doctor tells you otherwise, it is especially important to avoid using the following skin products on the same area as tretinoin:
- Any other topical acne product or skin product containing a peeling agent (such as benzoyl peroxide, resorcinol, salicylic acid, or sulfur)
- Hair products that are irritating, such as permanents or hair removal products
- Skin products that cause sensitivity to the sun, such as those containing spices or limes
- Skin products containing a large amount of alcohol, such as astringents, shaving creams, or after-shave lotions
- Skin products that are too drying or abrasive, such as some cosmetics, soaps, or skin cleansers
Using these products along with tretinoin may cause mild to severe irritation of the skin. Although skin irritation can occur, some doctors sometimes allow benzoyl peroxide to be used with tretinoin to treat acne. Usually tretinoin is applied at night so that it does not cause a problem with any other topical products that you might use during the day. Check with your doctor before using topical medicines with tretinoin.
During the first 6 months of use, avoid overexposing the treated areas to sunlight, wind, or cold weather. The skin will be more prone to sunburn, dryness, or irritation, especially during the first 2 or 3 weeks. However, you should not stop using this medicine unless the skin irritation becomes too severe. Do not use a sunlamp .
To help tretinoin work properly, regularly use sunscreen or sunblocking lotions with a sun protection factor (SPF) of at least 15. Also, wear protective clothing and hats, and apply creams, lotions, or moisturizers often.
Check with your doctor at any time your skin becomes too dry and irritated. Your health care professional can help you choose the right skin products for you to reduce skin dryness and irritation and may include the following:
- For patients using tretinoin for the treatment of acne:
- Regular use of water-based creams or lotions helps to reduce skin irritation or dryness that may be caused by the use of tretinoin.
- For patients using tretinoin for the treatment of fine wrinkling, dark spots, and rough skin caused by the sun:
- This medicine should be used as part of an ongoing program to avoid further damage to your skin from the sun. This program includes staying out of the sun when possible or wearing proper clothing or hats to protect your skin from sunlight.
- Regular use of oil-based creams or lotions helps to reduce skin irritation or dryness caused by the use of tretinoin.
Side Effects of This Medicine
In some animal studies, tretinoin has been shown to cause skin tumors to develop faster when the treated area is exposed to ultraviolet light (sunlight or artificial sunlight from a sunlamp). Other studies have not shown the same result and more studies need to be done. It is not known if tretinoin causes skin tumors to develop faster in humans.
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- More common
- Burning feeling or stinging skin (severe); lightening of skin of treated area, unexpected; peeling of skin (severe); redness of skin (severe) ; unusual dryness of skin (severe)
- Darkening of treated skin
Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:
- More common
- Burning feeling, stinging, or tingling of skin (mild)—lasting for a short time after first applying the medicine; chapping or slight peeling of skin (mild); redness of skin (mild); unusual dryness of skin (mild); unusually warm skin (mild)
The side effects will go away after you stop using tretinoin. On the rare chance that your skin color changes, this effect may last for several months before your skin color returns to normal.
Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, tretinoin is used in certain patients with the following medical conditions:
- Keratosis follicularis (skin disorder of small, red bumps)
- Verruca plana (flat warts)
Other than the above information, there is no additional information relating to its proper use, precautions, or side effects for these uses.