Topical Tretinoin benefit risk danger side effects, cream use for acne
February 1 2017

Topical tretinoin helps reduce wrinkles on the skin and it is very effective. However, perhaps this skin product should be used less frequently in order to avoid side effects or potential dangers. Tretinoin is a synthetic form of vitamin A.

Topical tretinoin therapy and all-cause mortality
Arch Dermatol. 2009.Weinstock MA, Bingham SF, Lew RA, Hall R, Eilers D, Kirsner R, Naylor M, Kalivas J, Cole G, Marcolivio K, Collins J, Digiovanna JJ, Vertrees JE; Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) Trial Group.Dermatoepidemiology Unit, VA Medical Center, Providence, RI, USA.
To evaluate the relation of topical tretinoin, a commonly used retinoid cream, with all-cause mortality in the Veterans Affairs Topical Tretinoin Chemoprevention Trial (VATTC). The planned outcome of this trial was risk of keratinocyte carcinoma, and systemic administration of certain retinoid compounds has been shown to reduce risk of this cancer but has also been associated with increased mortality risk among smokers. The VATTC Trial was a blinded randomized chemoprevention trial, with 2- to 6-year follow-up. Oversight was provided by multiple independent committees. A total of 1131 veterans were randomized. Their mean age was 71 years. Patients with a very high estimated short-term risk of death were excluded. Interventions Application of tretinoin, 0.1%, or vehicle control cream twice daily to the face and ears. The intervention was terminated 6 months early because of an excessive number of deaths in the tretinoin-treated group. Post hoc analysis of this difference revealed minor imbalances in age, comorbidity, and smoking status, all of which were important predictors of death. After adjusting for these imbalances, the difference in mortality between the randomized groups remained statistically significant. We observed an association of topical tretinoin therapy with death, but we do not infer a causal association that current evidence suggests is unlikely.

Hair growth
Efficacy of 5% minoxidil versus combined 5% minoxidil and 0.01% topical tretinoin for male pattern hair loss: a randomized, double-blind, comparative clinical trial.
Am J Clin Dermatol. 2007. Department of Dermatology, Seoul National University College of Medicine, and Seoul National University Boramae Hospital, Seoul, Korea.
5% topical minoxidil solution has been widely used to stimulate new hair growth and help stop hair loss in men with androgenetic alopecia. However, it is not convenient for patients to continue applying the solution twice daily on a regular basis. Topical tretinoin is known to increase the percutaneous absorption of minoxidil and, therefore, to enhance the response of AGA to minoxidil. For this reason, it was assumed that topical tretinoin would be helpful in alleviating the inconvenience associated with the recommended twice-daily application of minoxidil. We compared the efficacy and safety of therapy using a combined solution of 5% minoxidil and 0.01% topical tretinoin once daily with those of the conventional 5% topical minoxidil therapy applied twice daily in the treatment of androgenetic alopecia. The efficacy and safety of combined 5% minoxidil and 0.01% topical tretinoin once-daily therapy appear to be equivalent to those of conventional 5% minoxidil twice-daily therapy for the treatment of androgenetic alopecia.

Side effects, safety
Tolerability of high-dose topical tretinoin: the Veterans Affairs Topical Tretinoin Chemoprevention Trial.
Br J Dermatol. 2009; Geng A, Weinstock MA, Hall R, Eilers D, Naylor M, Kalivas J; VATTC Trial Group. Weinstock M, Marcolivio K, Weinstock M, Bingham S, DiGiovanna JJ, Hall R, Naylor M, Taylor JR, Sidhu-Malik N, Hannah D, Eilers D, Liang T, Sakla N, Kreuger A, Cole G, Jeffes E, Labrador T, Taylor JR, Kirsner R, Kerri JE, Falabella AG, Givens M, Naylor M, Benson MB, Perry L, Kalivas J, Yanni C, Targovnik S, Austin J, Collier S, Collins JF, Bingham S, Calvert B, Connor P, Crigler C, Davis D, Grubb P, Kelly J, Kirk G, Lawson K, Linzy L, Palmer L, Rhoads M, Sather M, Copeland E, Fye C, Gagne W, de Naranjo PG, Messick C, Vertrees J, Piepkorn M, Braverman I, Cole B. Boston Dermatology and Laser Center, Boston, MA, USA.
Topical tretinoin is a medication commonly used for acne that has potential application in the long-term treatment of photodamaged skin. However, there are few published data regarding the tolerability of high-dose tretinoin with long-term use. To assess the long-term tolerability of tretinoin 0.1% cream. A randomized, multicentre, double-blind, controlled trial for chemoprevention of keratinocyte carcinomas (i.e. basal cell or squamous cell carcinomas) using topical tretinoin cream to the face and ears was conducted. All participants were veterans and had a history of two or more keratinocyte carcinomas over the previous 5 years. Participants were examined (by a study dermatologist) and interviewed every 6 months (for up to 5.5 years to May 2004). Treatment comprised tretinoin 0.1% cream or vehicle control cream once daily, then twice daily as tolerated. Participants were instructed to step down application frequency to once daily or less if twice daily was not tolerated. The main outcome measures were reported side-effects, frequency of cream application and attendance at study visits. Appropriate data were available for four of the six clinical sites of this trial. Data from 736 randomized participants (mean age 71 years; 97% men) from four clinical sites were analysed. The tretinoin group more commonly reported one or more side-effects at the 6-month follow-up than the control group (61% vs. 42%). Side-effects decreased over time in both groups, but to a greater extent in the tretinoin group, and the difference became nonsignificant at 30 months. Burning was the most common side-effect. No unexpected adverse events were reported. Overall, the tolerability level of topical tretinoin was high in this study population, with almost 40% of the tretinoin group reporting no side-effects, and the majority (67%) tolerating at least once-daily dosing at 6-month follow-up. High-dose topical tretinoin is feasible for long-term use in this population.