Tretinoin (Retin-Aź) for Wrinkles & Aging Skin
Tretinoin (all-trans Retinoic acid), a derivative of vitamin A, is a first generation retinoid. Retin-A® brand is licensed for acne. Renova® brand is the only tretinoin formulation approved by the FDA for treating sun-damaged skin. The US FDA has not granted approval for Retin-A® as an anti-aging remedy.
Topical tretinoin formulations are used for:
- Photoaging skin.
- Acne vulgaris, acne scars
- Melasma. Significant improvement occurs after 24 weeks of tretinoin application3.
- Stretch marks (striae)4
Tretinoin (Retin-A, Renova) efficacy for aging skin
Unwanted changes in aging skin are dermal thinning, depletion of collagen production, and decreased lipid production. The consequences of these degenerative changes are fine lines and wrinkles, loss of elasticity, dryness, mottled pigmentation, textural changes, and coarseness. Signs of aging are caused not only by the natural aging process, but also by sun damage and the attack of free radicals on the skin.
Tretinoin has been evaluated in numerous clinical trials for the safety and efficacy in the rejuvenation of photoaged skin. Tretinoin not only clinically and biochemically repairs photoaged skin, but its application may also slow the aging process of the skin.
How long does it take to see results from Tretinoin? The noticeable improvement in appearance of photo-damaged skin is seen after 3-4 months of tretinoin application2, 7. Tretinoin improves visible signs of ageing such as facial wrinkles, fine lines, hyperpigmentation, freckles and age spots, rough skin texture, uneven tone, and visible pores. The disappearance of hyperpigmentation takes 1 year until it becomes noticeable.
Beneficial results will slowly regress once tretinoin is discontinued.
Tretinoin vs Tazarotene (Tazorac®)
Tazarotene 0.1% cream is superior to tretinoin 0.05% emollient cream in improving facial fine wrinkling and mottled hyperpigmentation8. Also, tazarotene beneficial effects become visible sooner. However, tretinoin causes less skin irritating side effects.
Tretinoin vs Retinol
Difference between Tretinoin (retinoic acid) and Retinol
Retinol (vitamin A alcohol), retinal (aldehyde), and retinoic acid all are the forms of vitamin A.
Retinol, a parent form of vitamin A, must be converted into retinaldehyde, and then retinaldehyde into all-trans retinoic acid to become active in the epidermis. Retinol approximately 20 times less potent than retinoic acid.
Retinol is not considered to be a drug. So, retinol-containing cosmetic products are sold over-the-counter.
Retinoic acid (tretinoin), the active metabolite of vitamin A, is classified as a prescription drug.
Tretinoin versus Retinol for photodamaged skin
Recent 2015 comparative study9 has shown that retinol at high concentrations provides comparable improvements to tretinoin in the appearance of photoaging.
Anti-aging mechanism of Tretinoin
- Modulates the proliferation and differentiation of the epidermal cells10
- Inhibits matrix metalloproteinases (enzymes responsible for collagen degradation) and in that way stimulates the new collagen synthesis11. In addition, when collagen damage has already occurred, tretinoin induces procollagen gene expression.
- Improves epidermal cell atypia12
- Reduces epidermal melanin content probably via inhibition of tyrosinase activity13.
- Increases epidermal and granular layer thickness, and promotes stratum corneum compaction14
- Tretinoin has been approved for the treatment of photoaging for many years. Currently tretinoin is the most extensively studied medicine for aging skin.
- Younger and healthier looking skin. Tretinoin noticeably improves the appearance of photoaged skin -- reduces fine wrinkles and hyperpigmentation; improves skin texture, tone, and complexion; fades brown spots and freckles.
- May prevent degenerative skin changes.
- Increases dermal thickness and promotes collagen synthesis.
- Low systemic toxicity.
- Tretinoin often cause local skin irritation, redness, itching, burning, dryness, erythema, and peeling (retinoid dermatitis).
- Photosensitivity. Tretinoin causes a heightened susceptibility to the sunlight requiring the user to be especially careful to minimize UV exposure and apply sunscreens.
- There is some concern that overuse of high-concentration tretinoin may cause excessive skin thinness over time.
- Systemic retinoids are teratogens. However, a number of studies have demonstrated that topical tretinoin is not associated with congenital abnormalities.
- Tretinoin really works but takes time and requires patience.
- 2. Nyirady J+ne N, Savin R, Shavin J, Voorhees JJ, Weiss J, Grossman R. Tretinoin cream 0.02% for the treatment of photodamaged facial skin: a review of 2 double-blind clinical studies. Cutis. 2001 Aug;68(2):135-42.
- 3. Griffiths CE, Finkel LJ, Ditre CM, Hamilton TA, Ellis CN, Voorhees JJ. Topical tretinoin (retinoic acid) improves melasma. A vehicle-controlled, clinical trial. Br J Dermatol. 1993 Oct;129(4):415-21.
- 4. Rangel O, Arias I, García E, Lopez-Padilla S. Topical tretinoin 0.1% for pregnancy-related abdominal striae: an open-label, multicenter, prospective study. Adv Ther. 2001 Jul-Aug;18(4):181-6. PubMed
- 5. Ertl GA, Levine N, Kligman AM. A comparison of the efficacy of topical tretinoin and low-dose oral isotretinoin in rosacea. Arch Dermatol. 1994 Mar;130(3):319-24.
- 6. Kang S, Fisher GJ, Voorhees JJ. Photoaging: pathogenesis, prevention, and treatment. Clin Geriatr Med. 2001 Nov;17(4):643-59
- 7. Ho ET, Trookman NS, Sperber BR, Rizer RL, Spindler R, Sonti S, Gotz V, Mehta R. A randomized, double-blind, controlled comparative trial of the anti-aging properties of non-prescription tri-retinol 1.1% vs. prescription tretinoin 0.025%. J Drugs Dermatol. 2012 Jan;11(1):64-9. PubMed
- 8. Lowe N, Gifford M, Tanghetti E, Poulin Y, Goldman M, Tse Y, Yamauchi P, Rosenzweig H, Kang S. Tazarotene 0.1% cream versus tretinoin 0.05% emollient cream in the treatment of photodamaged facial skin: a multicenter, double-blind, randomized, parallel-group study. J Cosmet Laser Ther. 2004 Jun;6(2):79-85. PubMed
- 9. Babcock M, Mehta RC, Makino ET. A randomized, double-blind, split-face study comparing the efficacy and tolerability of three retinol-based products vs. three tretinoin-based products in subjects with moderate to severe facial photodamage. J Drugs Dermatol. 2015 Jan;14(1):24-30. PubMed
- 10. Tur E, Hohl D, Jetten A, Panizzon R, Frenk E. Modification of late epidermal differentiation in photoaged skin treated with topical retinoic acid cream. Dermatology. 1995;191(2):124-8. PubMed
- 11. Lateef H, Stevens MJ, Varani J. All-trans-retinoic acid suppresses matrix metalloproteinase activity and increases collagen synthesis in diabetic human skin in organ culture. Am J Pathol. 2004 Jul;165(1):167-74. PubMed
- 12. Cho S, Lowe L, Hamilton TA, Fisher GJ, Voorhees JJ, Kang S. Long-term treatment of photoaged human skin with topical retinoic acid improves epidermal cell atypia and thickens the collagen band in papillary dermis. J Am Acad Dermatol. 2005 Nov;53(5):769-74. PubMed
- 13. Griffiths CE, Voorhees JJ. Topical retinoic acid for photoaging: clinical response and underlying mechanisms. Skin Pharmacol. 1993;6 Suppl 1:70-7.
- 14. Olsen EA, Katz HI, Levine N, Shupack J, Billys MM, Prawer S, Gold J, Stiller M, Lufrano L, Thorne EG. Tretinoin emollient cream: a new therapy for photodamaged skin. J Am Acad Dermatol. 1992 Feb;26(2 Pt 1):215-24. PubMed
- Generic name: Tretinoin, derivative of vitamin A
- Trade names:
Renova: Cream 0.02%, Cream 0.05%
Retin-A: Cream 0.025%, Cream 0.05%, Cream 0.1%; Gel 0.025%, Gel 0.01%
Retin-A Micro: Gel 0.04%, Gel 0.1%
- Pharmacologic category: Retinoid
- FDA approved: October 20, 1971
- Pregnancy risk factor: C
- Tretinoin has been the best-studied topical remedy for skin aging.
- It gives the hope to people searching for the ever-elusive Fountain of Youth.