Topical tretinoin and isotretinoin (another form of tretionoin) are useful in treating patients with comedonal acne. Isotretinoin, also known by many people as the tradename Roaccutane, can also be taken orally in capsule form.

Tretionoin and isotretinoin are both licensed to treat mild to moderate acne. Isotretinoin is especially licensed to treat non-inflammatory/ inflammatory lesions in patients with mild to moderate acne.

Topical Tretinoin

This can be described as the acid form of Vitamin A. It usually goes by the tradename of Retin-A (Janssen-Cilag) and is a prescription only medication. That is, you can only obtain this cream, if your doctor prescribes it and thinks that you may benefit from it. Tretinoin can also be obtained in gel (Retin- A gel) or lotion (Retin-A lotion) form.

A formulation of tretinoin and erythromycin (an antibacterial) can be obtained. It goes by the tradename of Aknemycin Plus (Crookes).

Topical Isotretinoin

This is also an acid form of Vitamin-A, and can be described as an isomer of tretinoin (isomer is another form of the same substance). It can be obtained in two preparations. The first is called Isotrex (Stiefel) which is in the form of a gel and the second , is called Isotrexin (Stiefel) gel which contains isotretinoin plus an antibacterial called erythromycin.

Cautions

1.Topical retinoids should be avoided in severe acne involving large areas

2.Exposure to UV light should be avoided

3.Use of abrasives (facial exfoliators etc.) in conjunction with retinoid creams should be avoided

4.If using benzoyl peroxide, allow for skin peeling to subside before using topical retinoids

Contraindications

1.Should be avoided in during pregnancy

2.Tretinoin is contraindicated in personal or familial history of cutaneous epithelioma.

Side effects

1.Skin burning, redness, stinging, itching,

2.Dry peeling skin

3.Temporary changes of skin pigmentation have been reported but this is less common

4.Eye blistering (irritation and swelling around the eye) have been reported but rarely

Efficacy

The topical retinoids are good at keeping (mild to moderate) acne at bay but by no means are they 100% effective in all people using them. If you find that you acne has not started to improve after 1-2 months of treatment with the topical retinoids, then it may be good to consult your doctor so that other alternatives can be suggested.

Your physician may prescrib oral retinoids or topical antibacterials depending on which ever he/she thinks is suitable for you.