From the Guidelines
Retinoids, specifically topical retinoids like tretinoin, adapalene, and tazarotene, are strongly recommended for the treatment of acne due to their comedolytic, anti-inflammatory, and ability to normalize follicular keratinization properties. For acne treatment, these topical retinoids are typically applied once daily in the evening to clean, dry skin, starting with lower concentrations applied every other day to minimize irritation, gradually increasing to daily use as tolerance develops 1. A pea-sized amount is sufficient for the entire face. The choice among tretinoin (0.025%-0.1%), adapalene (0.1%-0.3%), and tazarotene (0.05%-0.1%) may depend on the patient's skin type and tolerance, with adapalene often considered better tolerated than tretinoin, especially in its older formulations 1.
Key Points for Retinoid Use in Acne Treatment
- Topical retinoids are the core of topical therapy for acne because they are comedolytic, resolve the precursor microcomedone lesion, and are anti-inflammatory 1.
- Combination therapy with other agents like benzoyl peroxide or topical antibiotics may enhance efficacy and is recommended for patients with mixed types of acne lesions 1.
- Oral isotretinoin may be prescribed for moderate to severe acne at 0.5-1 mg/kg/day for 15-20 weeks, with cumulative doses of 120-150 mg/kg, under strict monitoring due to potential side effects including teratogenicity 1.
- Side effects management includes using sunscreen daily and moisturizing regularly to manage dryness, redness, and photosensitivity associated with topical retinoids 1.
Recommendations Based on Recent Guidelines
The most recent guidelines from 2024 recommend topical retinoids as a strong option for acne treatment, emphasizing their role in multimodal therapy that combines multiple mechanisms of action to target different aspects of acne pathogenesis 1. The guidelines also support the use of oral isotretinoin for severe nodular acne or moderate acne that is treatment-resistant or produces significant scarring or psychosocial distress, with careful monitoring for side effects 1.
Given the evidence, the use of retinoids, either topical or oral, under appropriate medical guidance, is a cornerstone in the management of acne, offering significant benefits in reducing acne lesions, preventing scarring, and improving quality of life.
From the FDA Drug Label
Tretinoin works deep inside your skin and this takes time. You cannot make tretinoin work any faster by applying more than one dose each day, but an excess amount of tretinoin may irritate your skin. Tretinoin Cream or Tretinoin Gel should be applied once a day, before retiring, to the skin where acne lesions appear, using enough to cover the entire affected area lightly. During the early weeks of therapy, an apparent exacerbation of inflammatory lesions may occur This is due to the action of the medication on deep, previously unseen lesions and should not be considered a reason to discontinue therapy. The uses of retinoids, such as tretinoin, in dermatology include the treatment of acne. The treatment regimen for tretinoin typically involves applying the medication once daily, before bedtime, to the affected area. It is essential to follow the physician's instructions carefully and be patient, as therapeutic results may take 2 to 3 weeks or more to appear.
- Apply a small amount to cover the entire affected area lightly
- Avoid excessive application, which can cause irritation
- Use mild, non-medicated soap and avoid harsh scrubbing
- Moisturizers or moisturizers with sunscreen that will not aggravate acne can be applied in the morning 2 Key points to consider when using tretinoin for acne treatment:
- Dosage and administration: Apply once a day, before retiring, to the skin where acne lesions appear
- Potential side effects: Excessive irritation, redness, or peeling, especially during the early weeks of therapy
- Therapeutic results: May take 2 to 3 weeks or more to appear, with continued improvement after 6 to 12 weeks of therapy 2
From the Research
Uses of Retinoids in Dermatology
- Retinoids, also known as retinoic acid derivatives, are used to treat various skin conditions, including acne, due to their ability to act against comedones and microcomedones and have direct anti-inflammatory effects 3, 4.
- Topical retinoids are effective in treating mild to moderate acne and are used as first-line treatment in most types of non-inflammatory and inflammatory acne 3, 4.
- Retinoids are also used to prevent the development of comedones, halting the progression to inflammatory lesions, and are the mainstay for treating common varieties of acne vulgaris 5.
Treatment Regimens for Acne
- Topical retinoids, such as tretinoin, isotretinoin, adapalene, and tazarotene, are approved for acne treatment and have a favorable safety profile, with local adverse effects being the most common 3, 4.
- The choice of topical retinoid depends on the severity of the acne, with tazarotene 0.1% being more effective than tretinoin 0.025% or 0.1% microsphere gel or adapalene 0.1% gel or cream 3.
- Adapalene 0.1% is equally effective to tretinoin 0.025% or tretinoin microsphere 0.1% gel or tretinoin 0.05% cream or isotretinoin 0.05% gel, but is better tolerated than tazarotene 0.1% gel 3.
- Combination therapy with topical retinoids and other agents, such as benzoyl peroxide and antibiotics, is recommended for inflammatory acne, as it can target multiple pathogenic factors 6.
Safety and Efficacy
- Topical retinoids have a favorable safety profile, with local adverse effects, such as erythema, dryness, itching, and stinging, being the most common 3, 4.
- The safety profile of topical retinoids differs from their systemic counterparts, and is related mainly to local adverse effects 3.
- Long-term use of topical retinoids has been shown to be effective and safe, with no risk of inducing bacterial resistance, and is recommended for maintenance treatment to prevent the formation of microcomedones 6, 7.