What are the prescription instructions for tretinoin (all-trans retinoic acid) cream for treating acne or fine wrinkles?

Tretinoin Cream Prescription Instructions for Acne and Fine Wrinkles

For treating acne or fine wrinkles, tretinoin cream should be applied as a thin layer once daily before bedtime to the affected areas, keeping away from eyes, mouth, nasal creases, and mucous membranes. 1, 2

Application Instructions

• Wash face with a mild, non-medicated soap and pat skin dry 2
• Wait 20-30 minutes after washing to ensure skin is completely dry before applying tretinoin (this minimizes potential irritation) 2
• Apply a pea-sized amount (approximately half an inch or less) of tretinoin cream to fingertip 2
• Dab the medication on forehead, chin, and both cheeks, then spread over the entire affected area 2
• Smooth gently into the skin until invisible 2
• Keep away from eyes, mouth, nasal creases, and mucous membranes 1
• Apply a moisturizer or moisturizer with sunscreen (non-comedogenic) every morning 2

Precautions and Warnings

• Avoid excessive sun exposure; use effective sunscreen and protective clothing when outdoors 1, 2
• Avoid artificial sunlamps/tanning beds while using tretinoin 2
• Avoid extreme weather conditions (wind, cold) that may irritate skin 1, 2
• Do not use with other potentially irritating topical medications unless directed by physician 1, 2
• Specific caution needed with keratolytic agents and photosensitizing agents due to potential interactions 1
• Pregnancy category C - consult physician if pregnant or nursing 1, 2
• Not established for use in children under 10 years of age 1
• Patients with fish allergies should use caution with specific formulations of tretinoin 0.05% 1

Expected Effects and Side Effects

• Initial skin adjustment period (2-4 weeks) may include redness, peeling, dryness, burning sensation, and skin irritation 1, 2
• New blemishes may appear at 3-6 weeks; continue treatment as this is part of the process 2
• Noticeable improvement typically occurs after 6-12 weeks of consistent use 2, 3
• Common adverse effects include dry skin, peeling, scaling, flaking, burning sensation, erythema, pruritus, pain of skin, sunburn, and hyper/hypopigmentation 1
• May increase susceptibility to sunburn 2

Maintenance Therapy

• Once acne is controlled, continue regular application as directed by physician 2
• For fine wrinkles/photodamage, improvements can be maintained with reduced frequency (three times weekly) after initial daily treatment period 4
• Discontinuation of therapy may result in some reversal of beneficial effects 4

Efficacy Information

• In controlled trials, 21-23% of patients using topical tretinoin had successful treatment of acne 1
• For photodamaged skin, tretinoin has been shown to reduce fine wrinkling, surface roughness, and mottled hyperpigmentation 5, 6
• Tretinoin increases collagen formation in photodamaged skin by up to 80% compared to vehicle alone 6
• In adult females with moderate acne, tretinoin 0.05% lotion showed 58.5% reduction in inflammatory lesions and 55.5% reduction in noninflammatory lesions after 12 weeks 3

Common Pitfalls to Avoid

• Using too much product (more is not better and may increase irritation) 2
• Applying to wet or recently washed skin (wait 20-30 minutes) 2
• Discontinuing treatment too early before seeing results 2
• Failing to use sun protection while on tretinoin therapy 2
• Using harsh cleansers or excessive washing (can worsen irritation) 2
• Expecting immediate results (improvement typically takes 6-12 weeks) 2, 3