Last Updated on August 8th, 2019
Retin-A is a synthetic, acidic form of vitamin also known as all-trans-retinoic acid or ATRA, as well as tretinoin (short for trans-retinoin). It is used to treat cystic acne and a condition called keratosis pilaris, which causes patches of thick, rough skin on any part of the body except the palms of the hands and the soles of the feet. Retin-A is the brand name for tretinoin used to treat acne; the medication is also available under the trade names Aberela, Airol, Atralin, Refissa, Renova, or Stieva-A (not to be confused with the herb stevia). Tretinoin is also used in treating hair loss1, age spots, leukemia, and Alzheimer’s disease.
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Vitamin A is well known for its importance to the skin2. Without enough vitamin A in the diet, the skin dries out and becomes inflamed. Vitamin A has to be absorbed from food, but the form of vitamin A in food has to be chemically transformed by the human body into the forms that regulate the growth of the skin.
In the 1960’s, pharmaceutical researchers began to look for ways to increase the availability of vitamin A. They learned how to imitate the process the liver uses to transform the retinyl esters in food into retinol for use in the cells. They also learned that retinol could be treated to create forms of two forms of vitamin A that are even more available to the skin, retinal and trans-retinoic acid. The skin can use tretinoin as soon as it is absorbed, without enzymatic transformation.
Tretinoin is not just a vitamin. It is a hormone. It can activate specific sequences of DNA in the chromosomes of skin cells. The result of activating DNA in the skin has three effects:
Tretinoin rejuvenates the skin4. The skin grows more rapidly and pulls away from pores, allowing them to open and drain. The thin skin over acne cysts breaks open and lets them drain without need for lancing or surgery. Thickening of the skin can even out smooth lines and growth of skin can obscure the borders around rough skin.
The problem with tretinoin is that it causes the skin to open where it is healthy as well as where it is sick. The skin between cysts can be red and inflamed. The rapid growth of the skin can also, ironically, increase the number and activity of sebaceous glands that make oily, waxy sebum. New pores can clog even while old cysts open.
Another problem with tretinoin is that it makes the skin thinner before it makes the skin thicker. It makes the skin more susceptible to sunburn, and increases the likelihood of skin injury when it is waxed for hair removal. (If you have to have hair removed, threading will not injure the skin.)
It is a good thing to apply noncomedogenic sunscreen5 when you are using tretinoin and being out in the sun.
It is no longer necessary to get a prescription for the form Retin-A known as tretinoin topical. Even though it costs as much as US $80 for one-half ounce (14 grams), tretinoin topical only costs 10% to 20% of the price of a visit to the dermatologist and a prescription for Retin-A. It is not necessary to have blood tests to monitor for potential toxicity of tretinoin topical because only tiny amounts of the medication are absorbed through the skin. Any formulation of tretinoin topical that uses microsphere technology will be absorbed more slowly and do more good for the skin with fewer side effects.
What kind of results can you expect from tretinoin topical?
It’s important to understand that tretinoin topical will not get rid of all of your blemishes. People who have fair skin usually have 60% fewer pimples and 50% fewer blackheads and whiteheads after eight weeks. People who have dark skin typically have about 50% fewer pimples and 40% fewer blackheads and whiteheads after eight weeks—if not other treatments are used.
Some people use both tretinoin topical and benzoyl peroxide6. Tretinoin is used to open the skin and benzoyl peroxide is used to kill acne bacteria as they are being released from deep pores. The effects of the two products are additive, but the side effects of the two products are also additive. Both benzoyl peroxide and tretinoin topical increase sensitivity to sunburn, so it is essential to use sunscreen during treatment.
Some people use both tretinoin topical and glycolic acid. One study even suggests7 that they are safe for dark skin—but be careful. Use glycolic acid as a skin peel and rinse it off your skin before applying tretinoin topical. Be sure to use sunscreen if you use either product on your skin, especially if you have dark skin.
In the North America, Canada, Australia, and New Zealand, you need a prescription to get products that combine Retin-A and antibiotics. Usually products that combine tretinoin topical and clindamycin get the best results8. Adding an antibiotic will get rid of about 20% more pimples and blemishes.
When tretinoin topical causes skin irritation9, you can see your physician for a prescription for adapalene (marketed as Differin, Teva, and Pimpal). Tretinoin topical is available over-the-counter (and from Amazon) in the USA in concentrations ranging from 0.01% to 0.05%, but it’s usually best to try the 0.05% strength first. If you experience skin irritation, then switch to a lower strength.
If you really want to get rid of all of your pimples and blemishes, it is usually best to follow a systematic skin care routine. Use topical tretinoin to get stubborn pimples under control, and then use Exposed Skin Care to maintain your clear complexion.
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