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Retinoids

»	What are retinoids?
»	How do vitamin A and retinoids exert their effect at a molecular level?
»	Which retinoids are prescribed for the treatment of skin diseases?
»	Are there any retinoids found in topical over-the-counter (OTC) products?
»	What are the clinical indications for using topical tretinoin?
»	What is the mechanism of action of tretinoin in acne vulgaris?
»	How should topical tretinoin be used to treat acne vulgaris?
»	After starting topical tretinoin for acne vulgaris, the patient reports that her acne is worse. Should she immediately discontinue the drug?
»	Is topical tretinoin cream really useful in treating photoinduced wrinkles?
»	Is there clinical evidence that topical retinoids improve melasma?
»	What are the side effects of topical tretinoin?
»	Is topical tretinoin safe to use during pregnancy or when nursing?
»	What are the clinical indications for tazarotene?
»	What are the clinical indications for alitretinoin?
»	Do retinoids have any role in the treatment or prevention of cancer?
»	What are the clinical indications for oral isotretinoin?
»	What is the mechanism of action of oral isotretinoin in acne vulgaris?
»	Are there any contraindications to the use of oral isotretinoin?
»	How is oral isotretinoin administered for the treatment of acne vulgaris?
»	What are the side effects of oral retinoid therapy?
»	Are there any strategies or treatments that reduce the dry skin and lips associated with retinoid therapy?
»	Are the clinical indications for acitretin the same as for isotretinoin?
»	What is the mechanism of action of acitretin?
»	How is acitretin administered for the treatment of psoriasis?
»	What are the contraindications for using oral acitretin?

What are the clinical indications for using topical tretinoin?

Topical tretinoin has received Food and Drug Administration (FDA) approval only for treatment of acne, mottled facial
pigmentation, and dermatoheliosis (sun-induced skin aging); however, it has been used in many other dermatologic conditions (Table 56-2).

Table 56-2. Therapeutic Applications of Topical Tretinoin
	FDA-APPROVED INDICATIONS	SELECTED NONAPPROVED APPLICATIONS
	Acne vulgaris Dermatoheliosis (photodamaged skin) Mottled facial hyperpigmentation	Acanthosis nigricans Actinic keratoses Fox-Fordyce disease Ichthyoses (e.g., ichthyosis vulgaris, lamellar ichthyosis) Keloids and hypertrophic scars Keratosis follicularis (Darier’s disease) Keratosis pilaris Lichen planus (cutaneous and oral) Linear epidermal nevus Melasma (chloasma) Nevus comedonicus Porokeratosis Postinflammatory hyperpigmentation Psoriasis Reactive perforating collagenosis Striae distensae (stretch marks) Verruca plana (flat warts)