Tretinoin (Retin-A) is a topical retinoid that is used as a treatment for active acne symptoms and minor acne scarring. Tretinoin was once the most commonly used topical retinoid for the treatment of acne, but newer retinoid medications (eg. Adapalene, Tazarotene) are now becoming more popular.
Retinoids are derivatives of Vitamin A. Retinoids can help improve acne symptoms in several ways. Retinoids decrease the activity of the sebaceous glands, which decreases the production of sebum. The decrease in sebum in eliminates decreases the amount of nutrients that are available for acne-causing bacteria that live deep within hair follicles. Retinoids can also affect the growth and differentiation of skin cells, which can help reduce the formation of clogged pores (comedomes). Retinoids also have anti-inflammatory affects which may help improve acne symptoms.
Tretinoin works by entering target cells and binding to to specific receptors called Retinoic Acid Receptors that are in the nucleus of cells. Once the retinoid binds to these receptors it changes how the genes of that cell are expressed. These changes in gene expression are what give retinoids their anti-acne properties.
Tretinoin can be a valuable treatment for individuals with any type of acne (Acne Types: 1-4). Many clinical research studies have shown that regular use of Tretinoin can improve acne symptoms. But clinical research and patient reports demonstrate that complete resolution of acne symptoms is rare when Tretinoin is used alone.
Tretinoin is frequently combined with complementary acne treatments (eg. Antibiotics, Androgen Inhibitors, Light & Laser therapies, etc). Tretinoin and other topical retinoids tend to be more effective for the treatment of mild acne (Acne Types: 1-2) and less effective for moderate and severe forms of the disease (Acne Types: 3-4).
There are topical medications available that combine Tretinoin with a second antibacterial agent, such as the antibiotic Clindamycin (Treclin). These combinations can be synergistic, further decreasing bacterial growth and leading to greater improvements in acne symptoms. Tretinoin may also be combined with Over-The-Counter (OTC) topical treatments, like Benzoyl Peroxide, although this particular combination can be lead to excessive dryness and irritation of the skin.
The most common side effect of Tretinoin treatment is dryness of the skin. Tretinoin treatment decreases the production of sebum, and sebum is essential for moisturizing and protecting the skin. Tretinoin tends to have more significant side effects (eg. Dry skin) than newer topical retinoids, such as Adapalene.
The most serious potential side effect of Tretinoin is a risk of birth defects. All retinoids are teratogens (compounds that can cause birth defects). However, several studies have indicated that there is minimal risk to the fetus from the topical use of retinoids, including Tretinoin. Nonetheless, the use of any type of retinoid is generally avoided in all women who are pregnant or may become pregnant during treatment.