What to Know About Topical Retinoids for Acne

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In This Article

Topical retinoids are a class of prescription medications used to control comodonal acne (blackheads and whiteheads). Also referred to as retinoic acid or vitamin A acid, topical retinoids are available as gels, ointments, creams, or foams to be applied directly to the skin. They work by promoting the exfoliation of dead skin cells as well as by boosting the production of new skin cells. The new cells then push dead cells and excess oil out of blocked pores. Retinoids also have anti-inflammatory properties.

There are two retinoids prescribed for acne: tretinoin topical, prescribed for acne under the brand names Retin-A, Avita, and others; and tazarotene topical (Tazorac and Fabior). Both are available in generic formulations.

Also prescribed for acne is Differin (adapalene) that works like a retinoid but is gentler. Differin is available by prescription in a 0.3% formulation and over the counter in a 0.1% formlation.

Topical retinoids are not the same as retinols. Retinoids are stronger and available only by prescription. Retinols can be purchased over the counter, typically in anti-aging products.

Retinoids may be prescribed on their own or in combination with other acne therapies such as antibiotics, benzoyl peroxide, or salicylic acid.

Uses

Topical retinoids are approved by the Food and Drug Administration (FDA) to treat whiteheads, blackheads, and acne lesions in children 12 and up and in adults.

Topical retinoids also are prescribed to help diminish signs of aging, including hyperpigmentation (dark spots on skin) and fine lines and wrinkles. When used for this purpose, some retinoids are sold under different brand names—for example, Renova (tretinoin) and Avage (tazarotene).

They sometimes are used to treat certain skin conditions besides acne, such as keratosis pilaris and psoriasis.

Before Using

A dermatologist is likely to prescribe a retinoid to treat acne only after other measures have failed to control the condition—in particular, over-the-counter (OTC) products containing salicylic acid, benzoyl peroxide, sulphur, and other active ingredients and/or antiobiotics.

The doctor will take into consideration certain aspects of a patient's medical history as well. Eczema may be a contraindication for using retinoids for acne. And because the oral form of retinoic acid, isotretinoin (formerly sold as Accutane), is known to cause severe birth defects, women who are pregnant, planning to become pregnant, or breastfeeding may be advised not to use topical retinoids.

Dosage

Topical retinoids came in various strengths depending on the formulation:

Tretinoin

  • Available as a cream in three strengths: 0.025%, 0.05%, and 0.1%
  • Available as a gel in 0.01% and 0.025% strengths
  • Available as a liquid (the most potent) in a 0.05% strength
  • Retin-A Micro 0.1% is a slow-release option that is less irritating to the skin.

Tazarotene

  • Available as a gel in 0.05% and 0.1% strengths

Differin

  • Available as a prescription gel in 0.3% strength
  • Available as n OTC gel in 0.1% gel

All listed dosages are according to the drug manufacturer. Check your prescription and talk to your doctor to make sure you are taking the right dose for you.

Modifications

Oral versions of retinoids are available by prescription only.

Isotretinoin, formerly known as Accutane, is an oral—not a topical—retinoid that is sometimes prescribed for severe acne. It's associated with miscarriage and birth defects and should therefore never be taken while pregnant, breastfeeding, or during the month prior to conception.

How to Take and Store

For treating acne, retinoids are applied directly to affected areas. Skin should be clean and completely dry. Whatever the formulation, it should be applied in a very thin layer with clean hands. Most dermatologists direct patients to use retinoids once a day, in the evening.

A retinoid should not be used on broken, infected, or sunburned skin. It should not be applied to the eyes, nose, mouth, or genitals.

Side Effects

Topical retinoids are generally regarded as safe to use, but like all medications they do have some side effects to be aware of.

Common

Most mild side effects experienced at the beginning of use of a retinoid subside after two to four weeks, including:

  • A warm sensation on the skin upon applying
  • Mild skin irritation such as itching, peeling, scaling, and burning
  • A worsening of acne at the beginning of use that usually resolves
  • Hyperpigmentation (darkening) of small areas of skin resulting from irritation caused by retinoids (retinoid dermatitis)
  • Increased sensitivity to cold and heat

The most important side effect of retinoids is an increased sensitivity to ultraviolet rays that can lead to severe sunburn. It's vital when using a retinoid to be vigilant about using sunscreen, wearing hats and sunglasses, and staying out of direct sunlight as much as possible.

Rare

  • Worsening acne that does not subside after two to four weeks of use
  • Eczema or contact dermatitis resulting from an allergic reaction to retinoids

Severe

  • An allergic reaction causing symptoms such as stinging, burning, extreme dryness, swelling, itching, peeling, blistering, difficulty breathing

Seek immediate medical attention if allergic symptoms develop.

Warnings and Interactions

Retinoids should not be used with certain other acne treatments. Combining a retinoid with a product containing salicylic acid can result in irritation, redness, and peeling.

Retinoids and benzoyl peroxide can sometimes be used together. However, certain concentrations of the latter may degrade the retinoid, making it less effective.

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Article Sources
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