Acne Treatment with Retinoid Agents

Tretinoin - Topical Acne Treatment

Agents with tretinoin (retinoic acid; Retin A, Avita) are comedolytic and often are used in conjunction with antibacterial agents. They may produce significant erythema and dryness as a side effect. They are best used once nightly and applied sparingly.

Mild photosensitivity may occur initially, but after 2 weeks of use there is no increased sun sensitivity.

Tretinoin is available in a wide variety of vehicles and concentrations.

Retin A Micro may have fewer side effects than does the standard gel because of its slow-release formula. Patients generally start on Retin A 0.025% cream unless they have oily skin. If this is well tolerated, acne patients can increase the potency to the 0.05 or 0.1% strengths.

Acne patients with oily skin may tolerate higher initial cream concentrations, or the gel may be used. Avita is available only in one concentration of cream or gel. Acne patients should be cautioned that tretinoin may initially exacerbate acne, although improvement will follow. Some patients may require 1 to 2 months of therapy to become accustomed to this agent. We counsel patients to begin with small amounts of the drug and gradually increase the quantity as the skin becomes tolerant.

Tretinoin should not be applied at the same time benzoyl peroxide products are applied, as it may not retain its chemical stability.