In recent years new synthetic derivatives of Vitamin A (retinoids) have been developed for the treatment of various skin conditions, such as severe acne, sun spots, wrinkles, and psoriasis. Some retinoids may even help treat or prevent certain forms of skin cancer. Because of their promise, there has been considerable public interest and demand for these drugs.
Some retinoids have been approved as safe and effective for certain conditions by the Federal Drug Administration (FDA). Still, they are powerful drugs which, if not used correctly, can cause severe side effects. These drugs should only be used under the strict supervision of a physician. Also, people should have reasonable expectations of what retinoid and related products can and cannot do to cure disease or make one look younger or healthier.
Tretinoin is a drug approved in 1971 by the FDA for the topical treatment of some forms of acne. Applied to the skin, it can be very effective, but side effects are to be expected. A common side effect primarily associated with daily use is skin irritation, much like mild sunburn. Also, the skin is more sensitive to ultraviolet rays. A person using topical tretinoin should use a sunscreen with a skin protection factor (SPF) of at least 15 and avoid unnecessary sun exposure. The use of tretinoin must be carefully monitored by your dermasurgeon.
Isotretinoin (Accutane) is taken orally for treatment of severe nodular, inflammatory or scarring acne. Approved by the FDA, it is the most effective drug for this physically and psychologically disfiguring condition. However, it must be used with utmost caution, especially by women, because it can cause birth defects as well as other side effects.
Fortunately, there are several other ways to control mild forms of acne. Your dermasurgeon can advise you about appropriate treatment for acne before the use of accutane is considered. If appropriate treatment is started early enough, acne scarring can often be prevented. For those who develop acne scars, dermasurgeons have numerous treatment approaches that can be effectively tailored to the condition of the individual patient.
Dermatologists have done considerable research to establish the effectiveness of topical tretinoin for the treatment of aging and sun-damaged skin. Clinical studies of topical trentinoin formulations show them to be effective in diminishing fine lines and superficial wrinkles.
However, most tretinoins are skin irritants and can produce mild to moderate skin reactions. In addition, these drugs tend to increase skin sensitivity to ultraviolet rays.
Improvement of wrinkles may disappear when use of these drugs are discontinued. Nonetheless, they may be combined with other therapies in more advanced conditions. For instance, treatment alternatives to renew aging and sun-damaged skin include chemical peeling, laser resurfacing, microdermabrasion and soft tissue fillers. In some cases, it has been found that tretinoin may offer preventive value and can reduce the need to repeat these procedures or increase the time between them. A dermasurgeon should be consulted as to the appropriateness and effectiveness of different procedures, which will vary from patient to patient.
There is the possibility that tretinoin derivatives might one day prove to be an effective weapon against skin malignancies. Some initial studies have shown that the drug might inhibit, perhaps reverse, the development of sun spots which can develop into skin cancer. For the foreseeable future, however, the best preventive steps against skin cancer by ultra-violet rays are to avoid tanning lights; minimize exposure to the sun; and wear a sunscreen (SPF 15 or better) and protective clothing.
Etretinate is a retinoid taken orally. Cleared by the FDA, the drug has brought good results in many cases of severe psoriasis, but it is usually reserved for use when the disease is not responsive to other therapy. It is not a drug for everyone. It is extremely potent and can have serious side effects, particularly in pregnant women. A dermasurgeon should be consulted for the treatment of psoriasis and other scaling diseases.
Adaptalene is a topical retinoid that can be effective in controlling psoriasis, usually in combination with other skin creams. Adaptalene also shows promise in the treatment of sun-damaged skin.
For more information on skin conditions and treatments, along with a list of ASDS members in your state, please visit the Find a dermasurgeon section of our Web site.