Tretinoin (Topical)

Tretinoin is used to treat acne or other skin conditions as decided by your doctor. It helps keep skin pores clear.

One type of tretinoin cream is used to treat fine wrinkles, dark spots, or rough skin on the face caused by sun damage. It works by lightening the skin, replacing older skin with newer skin, and slowing down how the body gets rid of skin cells that may have been damaged by the sun. Tretinoin works best as part of a skin care routine that includes protecting the treated skin from the sun. However, it does not completely or permanently remove these skin issues or significantly improve more noticeable changes in the skin, such as deep wrinkles caused by sun exposure or aging.

This medicine is available only with your doctor's prescription.

It is very important for your doctor to check your or your child's progress at regular visits to ensure that this medicine is working properly and to look for unwanted effects.

In the first 3 weeks of using tretinoin, your skin may become irritated. Your acne may also appear to get worse before it gets better. It may take more than 12 weeks to see full improvement in your acne, even if you use the medicine every day. Contact your doctor if skin irritation becomes severe or if your acne does not improve within 8 to 12 weeks.

Do not wash the skin treated with tretinoin for at least 1 hour after applying it.

Avoid using any topical medicine on the same area within 1 hour before or after using tretinoin. If you do, tretinoin may not work properly or skin irritation might happen.

Unless your doctor instructs you otherwise, it is especially important to avoid using the following skin products on the same area as tretinoin:

• Any other topical acne product or skin product that contains a peeling agent (e.g., benzoyl peroxide, resorcinol, salicylic acid, or sulfur).
• Irritating hair products, such as permanents or hair removal products.
• Skin products that can make you more sensitive to the sun, including those with spices or limes.
• Skin products with a high alcohol content (e.g., astringents, shaving creams, or after-shave lotions).
• Skin products that are too drying or abrasive, like some cosmetics, soaps, or skin cleansers.

Using these products along with tretinoin may lead to mild to severe skin irritation. While skin irritation can happen, some doctors sometimes allow benzoyl peroxide to be used with tretinoin for acne treatment. Typically, tretinoin is applied at night to avoid issues with other topical products that you might use during the day. Check with your doctor before using topical medicines with tretinoin.

During the first 6 months of use, avoid overexposing the treated areas to sunlight, wind, or cold weather. The skin will be more likely to sunburn, dry out, or become irritated, especially in the first 2 or 3 weeks. However, do not stop using this medicine unless the skin irritation becomes too severe. Do not use a sunlamp.

To help tretinoin work effectively, regularly use sunscreen or sunblocking lotions with a sun protection factor (SPF) of at least 15. Also, wear protective clothing and hats, and apply creams, lotions, or moisturizers frequently.

Contact your doctor if your skin becomes too dry and irritated. Your doctor can help you choose the right skin products to reduce dryness and irritation, which may include the following:

• For patients using tretinoin for acne treatment: Regular use of water-based creams or lotions helps to reduce skin irritation or dryness caused by tretinoin.
• For patients using tretinoin for fine wrinkling, dark spots, and rough skin from the sun: This medicine should be part of a program to prevent further skin damage from the sun. This program includes staying out of the sun when possible or wearing appropriate clothing or hats for protection. Regular use of oil-based creams or lotions helps to reduce skin irritation or dryness caused by tretinoin.

In deciding to use a medicine, you and your doctor need to consider the risks and benefits. For this medicine, keep the following in mind:

Allergies

Inform your doctor if you have ever had any unusual or allergic reactions to this medicine or any other medicines. Also, let your healthcare professional know about any other allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Studies have not been done to determine the effects of tretinoin in children younger than 9 years old. Its safety and effectiveness in this age group have not been established.

Geriatric

Studies so far have not shown any specific problems in elderly patients that would limit the usefulness of tretinoin.

Breast Feeding

There are no adequate studies in women to determine the risk to infants when using this medication during breastfeeding. Consider the potential benefits and risks before using this medication while breastfeeding.

Interactions with Medicines

Some medicines should not be used together at all, while others can be used together even if interactions might happen. In these situations, your doctor may want to adjust the dose or take other precautions. Inform your healthcare professional if you are taking any other prescription or non-prescription (over-the-counter [OTC]) medicines.

Interactions with Food/Tobacco/Alcohol

Some medicines should not be taken around mealtime or with certain foods due to possible interactions. Using alcohol or tobacco with certain medicines may also lead to interactions. Talk to your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Other medical issues may impact the use of this medicine. Make sure to tell your doctor about any other medical problems you have, particularly:

• Dermatitis, seborrheic (dandruff) or
• Eczema (skin problem) or
• Fish allergy or
• Sunburn—Use with caution. May cause or worsen skin irritation, itching, or other skin issues.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do, they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

• Burning, stinging, peeling, redness, or unusual dryness of the skin (severe)

Less common

• Dryness, pain, redness, irritation, or peeling at the application site

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

• Burning, itching, stinging, scaling, or redness of the skin
• Chapping or slight peeling of the skin (mild)
• Darkening of the skin
• Lightening of normal skin color
• Lightening of treated areas of dark skin
• Redness of skin (mild)
• Unusual dryness of skin (mild)
• Unusually warm skin (mild)

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Altreno
• Atralin
• Avita
• Refissa
• Renova
• Retin-A
• Retin-A Micro
• Tretin-X

In Canada

• Rejuva-A
• Stieva-A Cream
• Stieva-A Cream Forte
• Stieva-A Gel
• Stieva-A Solution
• Vitamin A Acid

Available Dosage Forms:

• Gel/Jelly
• Cream
• Lotion

Therapeutic Class: Dermatological Agent

Chemical Class: Retinoid

Use this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause irritation of the skin.

This medicine should come with a patient information leaflet. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Do not apply this medicine to windburned or sunburned skin or on open wounds.

Do not use this medicine in or around the eyes or lips, or inside of the nose. Spread the medicine away from these areas when applying. If it accidentally gets on these areas, wash with water at once.

Before applying tretinoin, wash the skin with a mild soap or cleanser and warm water by using the tips of your fingers. Then gently pat dry. Do not scrub your face with a sponge or washcloth. Wait 20 to 30 minutes before applying this medicine to make sure the skin is completely dry. Applying tretinoin to wet skin can irritate it.

To use the cream, gel, or lotion form of this medicine:

• Apply just enough medicine to very lightly cover the affected areas, and rub in gently but well. A pea-sized amount is enough to cover the whole face.
• You may need to use a moisturizer while you are using the lotion.

To use the liquid form of this medicine:

• Using your fingertips, gauze pad, or cotton swab, apply enough tretinoin solution to cover the affected areas. If you use a gauze pad or a cotton swab for applying the medicine, avoid getting it too wet. This will help prevent the medicine from running into areas not intended for treatment.

After applying the medicine, wash your hands to remove any medicine that might remain on them.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For acne: For topical dosage forms (cream, gel, or liquid): Adults—Apply to the affected area(s) of the skin once a day, at bedtime. Children— Use and dose must be determined by your doctor. For topical dosage form (lotion): Adults and children 9 years of age and older—Apply a thin layer to the affected area(s) of the skin once a day. Children younger than 9 years of age— Use and dose must be determined by your doctor.
• For fine wrinkles, dark spots, or rough skin caused by the sun:For topical dosage form (cream): Adults younger than 50 years of age—Apply to the affected area(s) of the skin once a day, at bedtime. Adults 50 years of age and older—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not freeze.

The gel form is flammable and should be kept away from fire or excessive heat.