What is the steroid strength of tretinoin (all-trans retinoic acid) 0.025% topical cream?

From the Guidelines

Tretinoin 0.025% topical is considered a low-strength retinoid, not a steroid. It's essential to clarify that tretinoin belongs to the retinoid family (vitamin A derivatives) and is not a corticosteroid. This 0.025% concentration is typically the starting strength for most patients, making it milder than the 0.05% and 0.1% formulations that are also available. The low concentration helps minimize initial irritation while still providing therapeutic benefits for conditions like acne and photoaging.

Key Points to Consider

• Tretinoin is a retinoid, which is different from steroids, and is used for its therapeutic effects on skin conditions such as acne and photoaging 1.
• The 0.025% concentration of tretinoin is considered low-strength and is often used as a starting point for patients to minimize initial irritation while still providing benefits.
• When beginning tretinoin therapy, it's recommended to apply a pea-sized amount to clean, dry skin in the evening and use sunscreen during the day to reduce the risk of photosensitivity 1.
• Full benefits of tretinoin may take 8-12 weeks to become apparent, and it works by increasing cell turnover, normalizing skin cell development, and reducing inflammation in the skin.

Important Considerations for Use

• Tretinoin formulations should be applied in the evening due to their photolabile nature, and concurrent use with benzoyl peroxide (BP) should be avoided to prevent oxidation and inactivation 1.
• Daily sunscreen use can reduce sunburn risks associated with tretinoin use, and some formulations like adapalene 0.1% gel are available over the counter, while others require a prescription 1.

From the FDA Drug Label

Tretinoin Cream contains tretinoin in one of three strengths, 0.1%, 0.05%, or 0.025% by weight, in a hydrophilic cream vehicle of stearic acid, isopropyl myristate, polyoxyl 40 stearate, stearyl alcohol, xanthan gum, sorbic acid, butylated hydroxytoluene, and purified water. The strength of the steroid in tretinoin .025% topical is 0.025% by weight, which is a low-strength topical steroid 2.

• The active ingredient is tretinoin, also known as all-trans-retinoic acid, a derivative of vitamin A.
• It is used for the topical treatment of acne vulgaris.

From the Research

Tretinoin Strength and Steroid Classification

• Tretinoin is a retinol (vitamin A) derivative, not a steroid in the classical sense, but rather a retinoid 3, 4, 5, 6, 7.
• The strength of tretinoin can vary, with common concentrations including 0.01%, 0.025%, and 0.05% 3, 5.
• Tretinoin 0.025% is considered a moderate-strength topical retinoid, often used for the treatment of acne, photodamaged skin, and pigmentary disorders 5, 7.

Comparison to Other Topical Treatments

• Tretinoin 0.025% has been compared to other topical treatments, including azelaic acid, benzoyl peroxide, and salicylic acid, with varying results 6.
• Azelaic acid may be less effective than benzoyl peroxide, but comparable to tretinoin in terms of treatment response 6.
• Salicylic acid may have similar efficacy to tretinoin, but more studies are needed to confirm this 6.

Clinical Efficacy and Safety

• Tretinoin has been shown to be effective in reducing acne lesion counts, improving fine wrinkling, roughness, and pigmentation, and treating pigmentary disorders such as melasma and lentigines 3, 5, 7.
• Common adverse effects of topical tretinoin include local skin irritation, erythema, and peeling, which are typically mild to moderate in severity 3, 7.