How Tretinoin Cream 0.05% (Retin-A) is Transforming Australian Skincare Routines

How Tretinoin Cream 0.05% (Retin-A) is Transforming Australian Skincare Routines

Introduction 

Australia has always had an increased incidence of skin disorders than other nations with over 4% of the population reported to be suffering from at least one skin problem. According to the ACD ( Australian College of Dermatologists ), skin-related issues make up 14-18% of General Practitioner encounters out of which acne and photodamage ( solar keratosis ) occupy a major percentage. 

In fact, moderate to severe photodamage is quite common among the Queensland population and attributed to age, sex, and smoking incidence. Facial acne especially impacts the younger population aged 16-18 mostly affected by the problem. 

Among the numerous dermatological interventions available to deal with the problem, it is important to choose one that is effective and readily available making Tretinoin a popular and sought-after solution.

A brief word on Tretinoin 

Topical Tretinoin Cream or Retin-A is an ATRA ( All Trans retinoic Acid ) prescription medication used in the treatment of a wide range of dermatological problems. Structurally, the medication is a Vitamin A derivative that works on the mitotic activity of the skin cells to remove dead or damaged skin cells, replace older skin, and promote skin lightening.

retinol mechanism of action

Image Credit –https://labmuffin.com/does-retinol-work-skincare-science-scam/

In a study conducted on 15 volunteers with inflammatory acne, the use of Tretinoin reduced the microcomedones considerably within 12 weeks of application. 

Let’s understand micro comedones and Tretinoin in a better manner 

Microcomedones or follicular lesions are the initial stage of acne formation that occurs when the follicular glands are clogged with dead skin cells and excess sebum. During micro comedone formation, corneocytes or epidermal skin cells shed out of the skin develop sticky texture instead of being completely dislodged and accumulate in the pores with an increase in sebum production in a bottleneck form preventing the skin from sloughing off from the dead cells.

MicrocomedonesandComedonesnewwit

Image Credit – https://www.acne.org/what-is-acne-an-in-depth-look

In such cases, Tretinoin comes in handy in promoting corneocyte shedding and modifying the comedones structure to expel the comedones contents. Studies have shown Tretinoin to be the mainstay for acne with 12 weeks of Tretinoin therapy in strengths of 0.1% and 0.025% reducing microcomedones by 80 % and 35%.

Other than its effectiveness on micro comedones, Tretinoin use can help manage photodamage on skin with promoting anti ageing effects.

A word on Skin Photodamage and Tretinoin

Photodamage or overexposure to sunlight and visible radiation starts from the deepest dermal layers and manifests in the form of wrinkling, rough uneven skin texture, and pigmentation changes. 

Microscopical evaluation of photodamaged skin has shown a reduction in the dermal extracellular matrix with a negative impact on melanocytes and collagen network as a result.

Clinical evaluation of macroscopic signs of photodamage and skin elasticity

Image Credit – https://www.researchgate.net/figure/Clinical-evaluation-of-macroscopic-signs-of-photodamage-and-skin-elasticity_fig1_362402732

In such cases, application of Tretinoin reduces fine wrinkles and skin roughness with clearing the uneven pigmentation significantly.

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Image Credit – Treatment of photodamage with topical tretinoin: An overview – ScienceDirect.

Microscopical evaluation of Tretinoin-treated tissue has shown replacement of atrophic epidermis, uniform dispersion of melanin granules, new blood-vessel formation, and collagen formation in papillary dermis to reverse the structural damage and promote healthy and younger-looking skin. 

Other than dermal changes, tretinoin use has shown eradication of microscopic actinic keratosis ( appearing like bumps or raised patches on the top layer of skin ), increased transepidermal water loss ( water loss from stratum corneum ) and elimination of dysplasia and atypia ( factors behind pigmentation and mottling ). 

Further, regular use of Tretinoin results in exfoliation of retained horn in the follicles. A cutaneous horn is a cornified skin protrusion that appears in the sun exposed areas like face, nose, ears and forearms that are usually asymptomatic but can give rise to blessing and dry, scaly skin. 

Use of Tretinoin can exfoliate them out of the skin and regress their growth.

In a multicentre trial conducted to evaluate the effectiveness of Tretinoin Cream ( Retin-A ) on photodamaged Australian skin,125 subjects with photodamaged skin were enrolled in a study. 62 subjects were administered Tretinoin for two weeks while 63 were provided with a vehicle cream. 

After the initial two weeks of randomised treatment, all subjects applied the cream in the facial, neck and left hand or forearm one every night for the next 24 weeks. 

The investigators recorded changes in the clinical signs of photodamage using a 7-point scale while the subjects used a 5-point scale to record changes. Investigators used skin biopsies and silicone skin replicas to evaluate parameters like skin wrinkles, mottled skin appearance and roughness which are characteristic features of photodamaged skin,

At the end of the study, both researchers and subjects recorded significant improvements in skin laxity, roughness and hyperpigmentation after using Tretinoin. They further reported a positive effect on skin wrinkles, tightness colour and pores with it. The severity of photodamage was severely reversed in Tretinoin subjects in contrast to people using vehicle cream. 

Most importantly, the mean epidermal thickness that is rendered irregular in photodamaged skin was levelled out after using Tretinoin, giving it a moisturised and younger-looking appearance. Other than mild irritation that was tolerable and reversed after a few weeks of use, subjects did not experience any noticeable side effects. 

The study proved that Tretinoin Cream can significantly improve the appearance of photodamaged skin. Research has previously shown that Australians are more prone to sun sensitivity and photodamage than people living in Northern temperate countries and have higher rates of skin damage, severe facial lines and facial folds.with periorbital lines.

Other than its impact on photodamage, Tretinoin has further proven its effectiveness on facial lines when used at an early age along with decreasing the intensity of periorbital lines. Other Clinical Assessments have shown it to produce extremely satisfactory results for nasolabial folds and supralabial wrinkles and pores while being neutral for horizontal wrinkles and crow’s feet.

Conclusion 

While Tretinoin is a useful topical intervention for reducing sun and acne damage, it is a prescription medication and should be used as per the physician’s advice. Pregnant women should avoid using the medication as it can impact the foetus and lead to foetal risks. For best results, it is important to use it with a strong sunscreen or consult the dermatologist as to the proper way of using it. 

Reference Links:

https://pubmed.ncbi.nlm.nih.gov/3771853/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5064202/

https://pubmed.ncbi.nlm.nih.gov/7998893/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6001558/

https://onlinelibrary.wiley.com/doi/full/10.1111/jocd.12131

https://www.dermcoll.edu.au/wp-content/uploads/2019/10/More-Than-Skin-Deep-Skin-diseases-in-Australia-navigating-the-healthcare-system.pdf

https://pubmed.ncbi.nlm.nih.gov/33991136/

https://pubmed.ncbi.nlm.nih.gov/9892951/

Why Topical Retinoids Are Mainstay of Therapy for Acne – PMC.

An ultrastructural study of the effects of topical tretinoin on microcomedones

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