Generic Name

Tretinoin

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Classification

FDA Approved Indications

• Acne vulgaris (topical)
• To reduce fine wrinkles and mottled hyperpigmentation of facial skin (topical)
• Treatment of acute promyelocytic leukemia (systemic)

Mechanism of Action

Tretinoin modulates epithelial cell growth and differentiation by activating nuclear retinoic acid receptors, which influence gene transcription involved in cell differentiation and proliferation.

Dosage and Administration

Adult: Topical: Apply a thin film to affected area once daily at bedtime or as directed by physician. Systemic (for leukemia): Dose individualized based on body surface area and clinical response.

Pediatric: Topical: Same as adult; systemic use is limited and requires specialist supervision.

Geriatric: No specific adjustments necessary; monitor for skin irritation and systemic effects in sensitive individuals.

Renal Impairment: Use systemic tretinoin with caution; adjust based on clinical response and tolerance.

Hepatic Impairment: Use systemic tretinoin with caution; monitor liver function tests.

Pharmacokinetics

Absorption: Minimal when used topically; systemic absorption variable for systemic administration.

Distribution: Widely distributed; crosses blood-brain barrier when administered systemically.

Metabolism: Largely hepatic via oxidation and conjugation.

Excretion: Biliary and urinary excretion of metabolites.

Half Life: Approximately 0.5 to 2 hours (topical); longer in systemic use (about 1-2 days).

Contraindications

• Hypersensitivity to tretinoin or any component.
• Use with concomitant use of topical or systemic monoamine oxidase inhibitors.
• Pregnancy (category D for systemic use).

Precautions

• Avoid sun exposure or use sunscreen due to increased photosensitivity.
• Use caution in patients with eczema or dermatitis as irritation may increase.
• Use systemic tretinoin with caution in hepatic impairment.

Adverse Reactions - Common

• Skin irritation (redness, peeling, dryness) (Common)
• Increased photosensitivity (Common)
• Erythema (Common)
• Peeling, (Common)

Adverse Reactions - Serious

• Retinoic acid syndrome (fever, weight gain, respiratory distress, in systemic use for leukemia) (Rare)
• Severe skin irritation or allergic contact dermatitis (Uncommon)
• Elevated liver enzymes, hyperlipidemia (systemic use) (Uncommon)

Drug-Drug Interactions

• Systemic corticosteroids (may increase skin irritation)
• Other photosensitizing agents

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Use sunscreen daily and avoid excessive sun exposure.
• Apply a small amount to affected areas, avoiding eyes, mouth, and mucous membranes.
• Do not apply to broken or irritated skin.
• Report severe redness, peeling, or signs of allergic reaction.
• Pregnant women should avoid systemic tretinoin due to teratogenicity.

Special Considerations

Black Box Warnings:

• Teratogenicity: systemic tretinoin can cause birth defects. Patients must use effective contraception and be informed of risks.
• Retinoic acid syndrome (for leukemic patients): potentially fatal complication.

Genetic Factors: None established.

Lab Test Interference: May alter lipid levels, liver function tests.

Overdose Management

Signs/Symptoms: Severe skin irritation, dry skin, peeling, conjunctivitis, systemic toxicity in overdose cases.

Treatment: Discontinue tretinoin, symptomatic care, supportive measures, and in systemic overdose, hospitalization and supportive therapy.

Storage and Handling

Storage: Store at room temperature away from light and moisture.

Stability: Stable under recommended storage conditions.