Tretinoin is a type of retinoid treatment that is a derivative of vitamin A. It may appear in forms of a cream, gel, solution, or lotion, and it is used to treat many skin issues. With this treatment, newer skin cells are able to replace older ones, resulting in a more refurbished look.
This medication is not over the counter and is only able to be obtained if prescribed. The range for tretinoin usage varies, but adults and children older than 9 are typically in use of it. If there is a case of pregnancy or planned pregnancy, tretinoin will not be offered due to the great risks of birth defects.
Usages
In a way, tretinoin is a topical version of Accutane (isotretinoin) because of the overlap of the two being vitamin A derivatives. Vitamin A is a nutrient essential for vision, cell division, reproduction, and immunity. When using tretinoin and Accutante, new skin cells are grown, resulting in newer skin.
In terms of skin issues, tretinoin is able to solve a variety of them. Treatment of acne is the most common, usually for mild to moderate cases. Along with acne, tretinoin is additionally able to treat wrinkles, dark spots, rough skin that is the result of sun damage, and even acute promyelocytic leukemia (APL). APL occurs when too many immature blood cells are present in the blood and marrow. Tretinoin is able to cause the immature blood cells to develop into newer ones, slowing down or stopping the growth of cancer cells. This is used as a treatment option for patients who have seen no improvement and even negative results after using chemotherapy.
Percentages and Forms
Tretinoin is a very strong medication with varying forms and percentages. A doctor may choose to start or progress dosages depending on the patient’s condition. Typically, a lower dosage is given in the beginning to accustom the skin to the new active ingredient, but will increase in strength with time.
Topical gel
0.01%
0.025%
0.04%
0.05%
0.08%
0.1%
Topical cream
0.02%
0.025%
0.05%
0.06%
0.1%
Topical Lotion
0.05%
Topical Solution
0.05%
Purging and the Process
When first starting to use tretinoin, purging is bound to happen. Purging is a reaction consisting of breakouts, dryness, flakiness, and peeling, that is the result of the introduction of a new active ingredient to the skin. Purging may be observed throughout the first 3 weeks of progress, and not improve until up to 12 weeks. If the irritation becomes too severe or if improvement is not shown between 8-12 weeks, contacting a dermatologist would be the best option.
But there are steps that can be taken to combat the purging process, with the most common being the “sandwich method.” In this technique, moisturizer is first applied at the end of the skincare routine, followed by a layer of tretinoin before later applying another layer of moisturizer. This is helpful in maintaining moisture since tretinoin is known for being very drying.
Another common method is slowly increasing the frequency of tretinoin in the skincare routine. Tretinoin is a very strong active ingredient that may take the skin time to adjust to, so it is recommended to start off with once a week, then twice, then three times until daily application is reached.
Although sun protection is already important, tretinoin causes the skin to be additionally sensitive to the sun, making it crucial to take daily sun precautions. When tretinoin is applied and the skin comes into contact with light (fluorescent or sunlight), its effectiveness is degraded. For example, 0.05% micronized gel is degraded by 11% after eight hours of exposure to fluorescent light. The light sensitivity of this medication is why it is instructed to be applied at night.
Prescription
Tretinoin can only be obtained if prescribed by a doctor, so contacting one on the suspicion that it may improve one’s condition would be the first step. While it may not be the best solution for everyone, it has many benefits that may be helpful to some. Ensure that proper procedure and precautions are followed in order to have maximum improvement.
Personal Experiences
One reason I had chosen to research tretinoin was because of my own journey with it. My acne has never been the best, but had simmered down at one point until it got worse in April. I decided to visit my dermatologist at the time who had started me off with 0.1% tretinoin. This is what I suspected to be my “purging” stage because of the quick and sudden rise of acne. My face was covered with bumps on every available surface, ranging from my forehead, temples, chin, and cheeks. My nose was especially noticeable with five large and stubborn pimples, each which had grown in size from my usage of tretinoin. My skin was also excessively dry, in the way where it was becoming painful. In my bag I would have eczema lotion which would be applied every five minutes to my pink and irritated skin. The unprecedented rise of this may have been a result of starting out with a dosage that was too high, application that was too frequent, and overall a lack of knowledge on how to apply the medication in the first place. At this point, it had been a week or two of this and I decided to place a halt on my treatment.
I followed up with a new dermatologist a week later who suggested the option of Accutane to me, but I had decided to hold off on it until we had retried tretinoin. I believe that my skin benefited from the break that I took, being I restarted with the dosage of 0.025%. Instead of applying everyday, I familiarized myself with the new active ingredient and began with applying it once a week, and gradually increasing the frequency by week until I reached daily application. This was very beneficial and limited my purging effects and dryness. After my 0.025% dosage, I was upgraded to 0.1% and experienced no excess purging.
It has been 3 months of my consistent usage of tretinoin and my skin feels calmed and controlled. It is not to say I never experience the common breakout, but they have all been fairly maintained. It is important to note that a discontinuance of tretinoin has a high chance of returning to the state before beginning. When starting and applying tretinoin, it is essential that you continue on with your implication and usage of it. The tretinoin journey is difficult in the way that it is bound to worsen before improvement is seen– especially because your reaction may differ from others. If you are struggling with the purging state of this, remember to hold strong and that it will soon get better.
References:
1. Tretinoin (Topical Route) Precautions - Mayo Clinic. www.mayoclinic.org. https://www.mayoclinic.org/drugs-supplements/tretinoin-topical-route/precautions/drg-20066521?p=1
2. Tretinoin: MedlinePlus Drug Information. medlineplus.gov. Accessed September 6, 2023. https://medlineplus.gov/druginfo/meds/a608032.html#:~:text=Your%20doctor%20will%20order%20certain
3. Tretinoin vs. Isotretinoin (Accutane): What’s the Difference? | Apostrophe. www.apostrophe.com. Accessed September 6, 2023. https://www.apostrophe.com/slather/tretinoin-vs-isotretinoin/#:~:text=They%20are%20two%20of%20the
4. Mayo Clinic Staff. Vitamin A. Mayo Clinic. Published November 13, 2020. https://www.mayoclinic.org/drugs-supplements-vitamin-a/art-20365945#:~:text=Vitamin%20A%20(retinol%2C%20retinoic%20acid
5. Retin A, Renova (tretinoin topical) dosing, indications, interactions, adverse effects, and more. reference.medscape.com. https://reference.medscape.com/drug/retin-a-renova-tretinoin-topical-343555
6. Sun Exposure & Tretinoin or Retinol: What to Know | Apostrophe. www.apostrophe.com. Accessed September 6, 2023. https://www.apostrophe.com/slather/sun-exposure-tretinoin-retinol/#:~:text=Tretinoin%2C%20on%20the%20other%20hand
Author: Selena Chan
