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Retinoids

»What are retinoids?
»How do vitamin A and retinoids exert their effect at a molecular level?
»Which retinoids are prescribed for the treatment of skin diseases?
»Are there any retinoids found in topical over-the-counter (OTC) products?
»What are the clinical indications for using topical tretinoin?
»What is the mechanism of action of tretinoin in acne vulgaris?
»How should topical tretinoin be used to treat acne vulgaris?
»After starting topical tretinoin for acne vulgaris, the patient reports that her acne is worse. Should she immediately discontinue the drug?
»Is topical tretinoin cream really useful in treating photoinduced wrinkles?
»Is there clinical evidence that topical retinoids improve melasma?
»What are the side effects of topical tretinoin?
»Is topical tretinoin safe to use during pregnancy or when nursing?
»What are the clinical indications for tazarotene?
»What are the clinical indications for alitretinoin?
»Do retinoids have any role in the treatment or prevention of cancer?
»What are the clinical indications for oral isotretinoin?
»What is the mechanism of action of oral isotretinoin in acne vulgaris?
»Are there any contraindications to the use of oral isotretinoin?
»How is oral isotretinoin administered for the treatment of acne vulgaris?
»What are the side effects of oral retinoid therapy?
»Are there any strategies or treatments that reduce the dry skin and lips associated with retinoid therapy?
»Are the clinical indications for acitretin the same as for isotretinoin?
»What is the mechanism of action of acitretin?
»How is acitretin administered for the treatment of psoriasis?
»What are the contraindications for using oral acitretin?

 
 
 

Which retinoids are prescribed for the treatment of skin diseases?

 
Retinoids may be used topically or orally. Topical retinoids approved for use in the United States include tretinoin (alltrans retinoic acid), a naturally occurring metabolite of vitamin A; tazarotene, a synthetic retinoid; and alitretinoin (9-cisretinoic acid). Adapalene is a retinoid-like drug that is also available topically. The three oral synthetic retinoids available in the United States are isotretinoin, acitretin, and bexarotene. Etretinate was formerly available, but it has been pulled from the market and replaced by acitretin. Prescription retinoids are summarized in Table 56-1.







Table 56-1. Prescription Retinoids
TOPICAL PREPARATIONSORAL PREPARATIONS
 
Tretinoin (all-trans retinoic acid)
Retin-A (0.025%, 0.05%, 0.1% cream; 0.025% gel; 0.05% liquid)
Retin-A Micro (0.04%, 0.1% gel microsphere)
Renova (0.02%, 0.05% emollient cream)
Avita (0.025% cream and gel)
Atralin (0.05% gel)
Refissa (0.05% cream)

Tazarotene
Avage (0.1% cream)
Tazorac (0.05%, 0.1% gel)

Alitretinoin (9-cis-retinoic acid)
Panretin (0.1% gel)

Adapalene (retinoid-like drug)
Differin (0.1% gel, solution, cream, pledgets)
Epiduo (also contains benzoyl peroxide)
 
Isotretinoin (13-cis-retinoic acid)
Multiple brands (10-, 20-, 30-, and 40-mg capsules)

Acitretin
Soriatane (10- and 25-mg capsules)

Bexarotene
Targretin (75-mg capsules)
 Generic drugs appear as bold terms in the list.