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It is recommended that topical tretinoin not be used during pregnancy. 05% tretinoin cream was applied for 24 weeks, patients averaged a 27. {26} {49} Topical acne products, such as antibiotics or benzoyl peroxide, are used therapeutically with tretinoin to treat acne but can increase the risk of skin irritation. Patients who have been compliant but unsuccessful when using skin care and sun avoidance programs alone may benefit by adding tretinoin to the regimen. I was really hesitant to go on any tretinoin cream because of the dreaded 'it gets worse before it gets better'. Safety and efficacy have not been established for tretinoin's use in treatment of photoaging for adults 50 years of age and older. Tretinoin should not be applied to mucous membranes; contact near the eyes, lips, or nose should be avoided {01} {26}. Furthermore, topical tretinoin has caused delayed ossification in a number of bones in the offspring of rats and rabbits given 100 to 320 times the usual topical human dose, respectively. Tretinoin may improve but not clearly resolve hyperpigmented skin {20}. Tretinoin does not appreciably absorb ultraviolet light, cannot be regarded as a sunscreen, and will not protect the skin from redness {09}. {52} Topical tretinoin has been shown to be fetotoxic in rabbits given 100 times the usual topical human dose {01}. Treatment of acne vulgaris with topically applied erythromycin and tretinoin. If irritation becomes severe, tretinoin should be discontinued until irritation substantially lessens or heals. {01} {21} {26} {47} {49} Tretinoin diffuses across cell membranes and complexes with specific cytoplasmic receptors, which can then enter the cell's nucleus and bind to DNA. The copolymer is not considered a significant risk to humans when used topically at recommended doses, since the tretinoin aqueous gel contains less than 25 parts per million of the copolymer. , cytoplasmic tretinoin receptor) cannot activate the gene transcription factors or the hormone-response element. Tretinoin should be applied to dry skin (20 to 30 minutes should be allowed after washing) to reduce possible skin irritation that worsens or occurs more often if tretinoin is applied any earlier to nondry skin. {13} {15} Tretinoin has also been reported to suppress keratin synthesis {13} {16} {26} {29}. Tretinoin may be used with systemic antibiotics for treatment of all grades of acne, including severe (Grade IV) acne conglobata {04}; however, tretinoin is not effective when used alone for severe acne conglobata {08} {12} {14} {16}. Tretinoin improves the histological process of photoaging but cannot completely repair sun-damaged skin or eliminate all wrinkles {01} {02}.

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