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More about
Tretinoin
Though Tretinoin (Retinoid) is better known for its use
against Acne it is also very effective against the fine
lines and wrinkles caused by aging potentially leaving
the skin healthier and smoother after treatment.
In the past we found that the aesthetic industry used
Retinol instead of Tretinoin. It is only recently, if we look
at the past five to ten years that the latter has been used
and prescribed far more. If you wish to use tretinoin
based creams your doctor will have to prescribe it first
as it is a schedule 4 tretinoin based cream.
The originator product (tretinoin based cream) that is
available on the South African market, is a synthetic
form of Vitamin A. The FDA approved Tretinoin to be
used against mild to moderate acne (Acne Vulgaris) in
1971. After seeing the efficacy towards aging, the
active ingredient has been studied
extensively. If we have a look at the
significant benefits Vitamin A has on
the skin, then we realise how
important it becomes as it increases
the cell turnover rate, helps prevent
acne, stimulates collagen
production and it minimizes
wrinkles. By treating the skin with
tretinoin, the complexion of the skin
becomes brighter, and fades
darker marks as it decreases the
melanin under the skin.
Due to the fact that Tretinoin is
retinoic acid, it is more potent and
results are seen within 6-8 weeks
as it does not need to go through the
oxidation process like retinol, in order
to be converted to retinoic acid.
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flexible and drooping as well as wrinkles appear. As we
How and why does our skin
age?
The major cell type of the epidermis, known as
Keratinocytes (also known as corneocytes) represents
the outermost layer of the skin and make up about 90%
of the skin cells. They originate in the deepest layer of
the epidermis, the stratum basale and move up to the
final layer of the skin, the stratum corneum. These cells
secrete keratin and lipids that provide mechanical
strength to the skin. Keratinocytes are regularly shed
through skin peeling (desquamation). Desquamation is
the natural process in which skin cells are created,
sloughed away, and replaced. This happens on the
outermost layer of the skin called the epidermis.
The process of aging increase as the majority of
cells (keratinocytes) on the outer layer of the
skin (epidermis) become more adhesive
and don't slough off when it naturally
need to, in order to be replaced with
new cells. The skin begins to look
tired, dry and uneven. The epidermal
cells on the base now replicate slower
and increases the time the
keratinocytes stay on the outermost
layer of the skin. Due to this
pigmentation becomes irregular and
blotchy in appearance.
UV (ultraviolet radiation) light
breaks down the collagen and
elastin fibers in the skin. These
fibers form the connective tissue
that supports the skin. As this
layer breaks down, the skin
becomes weaker and less
When the sebaceous (oil) glands produce too much
sebum, these glands grow excessively which causes
age skin cells devide more slowly, and the middle layer
clogged pores and an inflammatory response is
of the skin, called the dermis, begins to thin. The dermis
is composed of a network of elastin and collagen fibers.
puberty (when the body produces more androgen like
As this network loosens and unravels with time, triggered. Genetics and hormonal changes i.e., at
depressions are created on the skin surface. Aging skin
hormones which cause sebaceous glands to enlarge
is also less able to retain moisture, less efficient in and produce more sebum), are the most common
secreting oil, and slower to heal. All these factors
causes of acne. Follicular hyperkeratinisation occurs
contribute to the development of wrinkles. As the dermis
when the cells of the follicle become cohesive and do
and collagen bundles become thinner and disordered,
which results in creases, fine lines and wrinkles develop. not shed normally on the surface of the skin. This
causes dead skin cells to clump together and pores get
blocked which in turn causes the back up of oil in the
follicle. Acne causing bacteria thrives in the oily depths
What does tretinoin do? of the pores. Sebum inside the pore is turned into fatty
acids by bacteria that proliferate due to the airless
Tretinoin (active ingredient) targets the epidermal cells environment, and inflammation in the nearby skin cells
known as suprabasal keratinocytes. It causes a large activates.
number of basal keratinocytes. This promotes shedding
of keratinized mature and dead skin cells at the surface The active ingredient Tretinoin, is available in the form of
and leaves the skin looking fresher, smoother and more topical cream and oral tablets where Isotretinoin is the
evenly pigmented. This initial improvement is only seen active ingredient in the tablets. Both Pharmaceutical
after 3-4 weeks of treatment, where pigment changes products are available only on prescription from a doctor
are generally seen between 6-8 weeks of treatment with or dermatologist. The tablets are often prescribed for
tretinoin. It is only after 3-6 months of using tretinoin that immediate or quicker intense treatment of severe acne
the renewing of the epidermis is visible. The skin should whereas the creams are used to aid in clearing mild to
now look and feel smoother, more robust and healthier. moderate acne.
The collagen budles now have an opportunity to thicken
and organise more easily causing the appearance of fine When tretinoin is applied onto the skin surface it allows
lines and wrinkles to be less. Tretinoin improves wrinkle the skin to exfoliate more rapidly. This leads to the
texture, decrease pore size pigmentation and sun expulsion of mature comedones and suppresses the
damage. formation of microcomedones. Now, the epidermal pores
are less likely to become blocked, the occurrence of
pimples, whiteheads and blackheads are reduced
The pathogenises of Acne significantly. The pores are now open due to quicker cell
turnover. Trapped bacteria and irritants are easily
Acne is a multifunction inflammatory disease that affects released as cells shed. When the patient uses a tretinoin
the skin's oil glands and hair follicles. The oil based topical cream or isotretinoin based tablet, sebum
(sebaceous) glands are usually attached to a hair follicle production is better regulated or controlled and future
and produces sebum (oil) which protects and lubricates breakouts are prevented. Tretinoin or isotretinoin based
the skin and hair. When sebum and dead skin cells products also has anti-inflammatory properties which
become trapped in a hair follicle, it forms a plug called a clears up active acne pustules. These pharmaceutical
microcomedo and this causes acne to occur. As dead products are typically used to treat inflammatory acne
skin cells ans oil (sebum) accumulates/buils up in the and comedonal breakouts as well as scarring due to
blocked pore, the microcomedo enlarges and can collagen production. Still, tretinoin is effective against
become an open comedo, better known as a black head inflammatory as well as non-inflammatory acne.
or a closed comedo better known as a white head.
These 3 factors play a major role in the development of
acne:
1. Too much sebum/oil gets produced
2. Follicular hyperkeratinisation
3. Acne-causing bacteria are present
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