Uses
Acne
Treatment of acne vulgaris, principally grades I–III, in which comedones, papules, and pustules predominate.
Generally not effective for treatment of severe pustular and deep nodulocystic acne; however, may be used as adjunctive therapy in the management of associated comedones.
Photoaging
Palliative therapy to improve dermatologic changes (e.g., fine wrinkling, mottled hyperpigmentation, roughness) associated with photodamage.
Use as an adjunct to a comprehensive skin care plan and sun avoidance program; reserve use for patients who do not achieve the desired effects with such programs alone (i.e., without tretinoin).
Safety and efficacy not established in individuals with moderately or highly pigmented skin or patients with actinic keratoses or a history of skin cancer.
Dosage and Administration
General
- Excessive use does not increase therapeutic effects and may produce marked inflammatory reactions (e.g., erythema, peeling, discomfort). (See Dermatologic Effects under Cautions.)
- Use of moisturizers concomitantly at night may dilute the therapeutic effect of the drug; if required, moisturizers should be used during the day.
Administration
Topical Administration
Apply topically to the skin as a cream, gel, or solution.
Gently wash skin with mild soap, pat dry, and wait 20–30 minutes before applying tretinoin to affected areas; avoid the eyes, ears, nostrils, mucous membranes, and mouth.
A transient feeling of warmth or minor stinging may occur immediately after application.
If therapy is not well tolerated, temporarily discontinue or decrease frequency of applications; reinitiate therapy when patient is able to tolerate the drug. Closely monitor patient response and tolerance to changes in dosage form, drug concentration, or application frequency.
Acne
Apply a sufficient amount of cream, gel, or solution to cover affected area lightly.
Apply cream or gel using clean fingertips.
Apply solution using clean fingertips, gauze pad, or cotton swab; avoid oversaturation of gauze or cotton so solution will not run onto unaffected areas.
Excessive application of gel results in “pilling” or “caking,” which minimizes overapplication.
Photoaging
Apply 0.02 or 0.05% cream topically to face using a clean fingertip; apply a sufficient amount to cover entire face lightly.
Gently wash treated skin with fingertips to peel away loose outer layers of the skin that may form during therapy. Erosion may occur if patients are not careful with scale removal.
Dosage
Pediatric Patients
Acne
Topical
Adolescents ≥12 years of age: Apply once daily at bedtime.
Because of potential to cause severe irritation and peeling, therapy can be initiated using a lower concentration cream or gel applied every 2 or 3 days at bedtime; if tolerated, solution or higher concentration cream or gel can be used.
Initial response (redness, scaling, and possibly more pronounced comedones) occurs within 7–10 days. Therapeutic effects usually are apparent after 2–3 weeks; optimal effects may require >6 weeks of therapy.
Relapses generally occur within 3–6 weeks after therapy is discontinued.
Adults
Acne
Topical
Apply once daily at bedtime.
Because of potential to cause severe irritation and peeling, therapy can be initiated using a lower concentration cream or gel applied every 2 or 3 days at bedtime; if tolerated, solution or higher concentration cream or gel can be used.
Initial response (redness, scaling, and possibly more pronounced comedones) occurs within 7–10 days. Therapeutic effects usually are apparent after 2–3 weeks; optimal effects may require >6 weeks of therapy.
Relapses generally occur within 3–6 weeks after therapy is discontinued.
Photoaging
Topical
Apply a pea-sized amount of the 0.02 or 0.05% cream once daily at bedtime.
Individualize dosage according to patient response and tolerance, depending on skin type, degree of photoaging present, race, and/or age of the patient. Mild scaling can be used as a guide in determining tolerance level.
If therapy is not well tolerated, may reduce frequency to every other night or every third night.
Maintenance regimen of 2–4 applications weekly suggested for some patients once maximum response has been achieved.
Therapeutic response occurs gradually over 6 months; clinically important decreases in fine wrinkles may not be apparent for 8 weeks.
Therapeutic effects may be lost when therapy and accompanying comprehensive skin care and sun avoidance are discontinued.
Prescribing Limits
Adults
Photoaging
Topical
Safety and efficacy of therapy with 0.02% cream for >52 weeks or with 0.05% cream for >48 weeks not established.
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