photoaging
† non-FDA-approved indication
Tretinoin, ATRA Indications and Dosage
For the treatment of acne vulgaris:
Topical dosage (e.g., Retin-A® cream, gel, liquid or Retin-A Micro® microsphere gel; Altinac™ cream; Avita™ gel or cream):
Adults, adolescents, and children >= 12 years: Apply a thin layer of topical tretinoin (0.025%, 0.04%, 0.05% or 0.1%, dependent on product selected) to the affected area(s) once daily at bedtime. Temporary discontinuation or reduction in application frequency may be necessary until the patient is able to tolerate the treatment. Frequency of application should be closely monitored by careful observation of the clinical response and skin tolerance; efficacy has not been established for less than once daily application frequency. Application of excessive amounts may result in ‘caking’ or ‘pilling’ and will not provide incremental efficacy. During the early weeks of treatment, an apparent exacerbation of inflammatory lesions may occur. If tolerated, this should not be considered a reason to discontinue therapy. Up to six weeks of therapy may be required before improvement is evident. This may be followed by a reduced dosage schedule.
Children < 12 years: Safety and effectiveness have not been established.
For adjunctive treatment of photoaging including palliation of fine facial wrinkles, facial mottled hyperpigmentation (i.e., ‘liver spots’), and facial skin roughness:
Topical dosage (Renova® 0.02% and 0.05%):
Adults: Apply a pea-sized amount to cover the entire affected area once daily before bedtime for 24 to 48 weeks. Most improvement is noted during the first 24 weeks of treatment. Use in combination with comprehensive skin care and sun avoidance programs. Brown spots begin to fade at around 6 - 8 weeks and there is a decrease in fine lines and wrinkles around 3 to 6 months. Discontinuation of treatment usually results in a loss of effect. The safety and efficacy of tretinoin therapy beyond 48 weeks has not been established.
For the treatment of melasma † :
Topical dosage:
Adults: Topical tretinoin 0.05 - 0.1% applied once daily to affected areas in combination with hydroquinone with or without hydrocortisone has been effective. Treatment should also include avoidance of sun exposure and use of sunscreens. To decrease side effects, some studies have applied tretinoin twice weekly instead of daily.
For the treatment of diseases of keratinization † (e.g., actinic keratosis † , ichthyosis † , keloids † , keratosis follicularis † ); acne rosacea † ; skin hyperpigmentation † :
Topical dosage:
Adults: Topical tretinoin 0.025% - 0.1% applied once daily to affected areas has been used in the treatment of various diseases of keratinization, often in combination with other agents.
For the treatment of acute promyelocytic leukemia (APL):
NOTE: Acute promyelocytic leukemia (APL) patients are considered high risk and administration of oral tretinoin may result in severe adverse reactions; administration should take place only under the supervision of a physician experienced in the treatment of acute leukemia and at a facility equipped to manage severe adverse reactions, including respiratory compromise. It should be determined prior to the initiation of treatment that the benefit of therapy outweighs the risks to the patient.
NOTE: Tretinoin has been designated an orphan drug by the FDA for this indication. Intravenous liposomal tretinoin (investigational) is discussed in a separate monograph.
