What to Know About Topical Retinoids for Acne

girl putting on acne cream
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Topical retinoids are a class of prescription medications used to treat and prevent comodonal acne (blackheads and whiteheads). Also referred to as retinoic acid or vitamin A acid, they come as gels, ointments, or creams to be applied directly to the skin. Topical retinoids work by promoting exfoliation and boosting the production of new skin cells, which in effect push excess oil and dead skin out of blocked pores. They also have anti-inflammatory properties.

Brand names of topical retinoids include Retin-A, Renova, Avita, and others (tretinoin), Tazorac, Avage, and Fabior (tazarotene), and Differin (adapalene), which is not a true retinoid but works like one and is therefore considered a retinoid-like medication. Each of these topical retinoids is available in generic form. Some also are an active ingredient in combination acne medications.

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. One exception is a less-potent version of Differin.

prescribed on their own or in combination with another acne therapy 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.

Non-Acne-Related Uses

Besides acne, topical retinoids are prescribed for:

Before Taking

For the prescription varieties of topical retinoids, your primary care doctor or dermatologist will assess the severity of your acne, your medical history, and any other medications you may be taking in order to determine whether topical retinoids are right for you.

Precautions and Contraindications

  • Talk to your doctor before using topical retinoids if you have eczema, or if are pregnant or nursing.
  • Acne may worsen with treatment before it gets better.
  • Wash your hands before and after applying topical retinoids
  • Take care not to get a retinoid medication your eyes, nose, mouth, or on your genitals.
  • Do not use on skin that has a cut or an infection, or is sunburned.
  • Use the medication regularly as directed.

Dosage

Patients are usually directed to apply a thin layer of topical retinoid cream, gel, or lotion to clean skin once a day before bed. Since the strengths of these drugs vary, follow your doctor's and the manufacturer's directions carefully.

Modifications

Oral versions of retinoids are available by prescription only.

How to Take and Store

The active ingredients in topical retinoids are heat-sensitive. Store below 80 degrees F.

Side Effects

Common

  • Increased risk of sunburn
  • Mild skin irritation such as itching, peeling, scaling, and burning
  • Changes in pigmentation to the skin being treated
  • Increased sensitivity to environmental cold and heat
  • A warm sensation on the skin upon applying
  • Mild side effects often subside after 2-4 weeks of use

Tazarotene carries the highest risk of skin irritation, though symptoms tend to resolve themselves within the first two to four weeks of use.

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

  • Extreme skin irritation indicative of an allergic reaction such as stinging, burning, extreme dryness, swelling, redness, peeling, or blistering
  • Swelling, extreme itchiness, rash, difficulty breathing

Seek immediate medical attention if allergic symptoms develop.

Warnings and Interactions

As there are important considerations in combining certain acne treatments, such as benzoyl peroxide and salicylic acid, with topical retinoids, you should talk to your doctor about your skincare regimen and any other products or medications you are using before starting these medications.

Prescription Topical Retinoids

Retin-A, Avita, and Renova (tretinoin) are all types of third-generation topical retinoids.

  • The product is available as a cream (0.025%, 0.05%, 0.1%), a gel (0.01%, 0.025%), and a liquid (0.05%).
  • The liquid product is considered the most potent.
  • Tretinoin breaks down when mixed with benzoyl peroxide so they cannot be applied at the same time.
  • Of the currently available brands, Retin-A Micro 0.1% is a slow-release option which is less irritating to the skin.

Tazorac, Avage, Zorac, and Fabior (tazarotene) are also third-generation prescription retinoids.

  • Tazarotene products are available in gel form in 0.05% and 0.1% strengths.
  • These products are more expensive than other topical retinoids.
  • Worsening acne is a rare side effect.

OTC Topical Retinoids

Differin (adapalene) is a newer product that is now available OTC and is used to treat mild to moderate acne. It is slightly different from the others and is considered retinoid-like, though not identical.

  • Adapalene is available as a gel or cream at 0.1% and 0.3% strength.
  • It is stable when used with benzoyl peroxide so they can be applied at the same time.
  • It is milder on the skin than other retinoid products.
  • It is known to have both exfoliation and anti-inflammatory properties.
  • Differin is considered equally effective as tretinoin.
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Article Sources

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