Tretinoin (Altreno, Atralin, Avita, Retin-A) is used to treat acne. Tretinoin is also used to reduce fine wrinkles (Refissa and Renova) and to improve spotty discoloration (Renova) and rough feeling skin (Renova) when used along with other skin care and sunlight avoidance programs. Tretinoin is in a class of medications called retinoids. It works by promoting peeling of affected skin areas and unclogging pores.

Tretinoin comes as a lotion (Altreno), cream (Avita, Refissa, Renova, Retin-A), and gel (Atralin, Avita, Retin-A). Tretinoin usually is used daily at bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use tretinoin exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Tretinoin controls acne but does not cure it. Your acne probably will get worse (red, scaling skin and an increase in acne sores) during the first 7 to10 days that you use this medication. Nevertheless, continue to use it; the acne sores should disappear. Usually 2 to 3 weeks (and sometimes more than 6 weeks) of regular use of tretinoin is required before improvement is seen.

Tretinoin may reduce fine wrinkles, spotty discoloration, and rough feeling skin but does not cure them. It may take 3 to 4 months or up to 6 months before you notice improvement. If you stop using tretinoin, the improvement may gradually disappear.

Use only nonmedicated cosmetics on cleansed skin. Do not use topical preparations with a lot of alcohol, menthol, spices, or lime (e.g., shaving lotions, astringents, and perfumes); they can sting your skin, especially when you first use tretinoin.

Do not use any other topical medications, especially benzoyl peroxide, hair removers, salicylic acid (wart remover), and dandruff shampoos containing sulfur or resorcinol unless your doctor directs you to do so. If you have used any of these topical medications recently, ask your doctor if you should wait before using tretinoin.

Your doctor may tell you to use moisturizer to help with dryness.

If you are to apply any form of tretinoin, follow these steps:

1. Wash your hands and affected skin area thoroughly with mild, bland soap (not medicated or abrasive soap or soap that dries the skin) and water. To be sure that your skin is thoroughly dry, wait 20 to 30 minutes before applying tretinoin.
2. Use clean fingertips to apply the medication.
3. Use enough medication to cover the affected area with a thin layer.

Apply the medication to the affected skin area only. Do not let tretinoin get into your eyes, ears, mouth, corners along your nose, or vaginal area. Do not apply on areas of sunburn.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using tretinoin,

• Tell your doctor and pharmacist if you are allergic to tretinoin, fish (if taking Altreno), any other medications, or any of the ingredients in tretinoin lotion, cream, or gel. Ask your pharmacist for a list of the ingredients..
• Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: certain antibiotics such as tetracyclines; antihistamines; diuretics (‘water pills’); fluoroquinolones such as ciprofloxacin (Cipro), delafloxacin (Baxdela), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), and ofloxacin; medications for mental illness and nausea; or sulfonamides such as co-trimoxazole (Bactrim, Septra), sulfadiazine, sulfamethizole (Urobiotic), and sulfisoxazole (Gantrisin). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• Tell your doctor if you have or have ever had eczema (a skin disease), actinic keratoses (scaly spots or patches on the top layer of the skin), skin cancer, or other skin conditions.
• Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while using tretinoin, call your doctor.
• Plan to avoid unnecessary or prolonged exposure to sunlight or ultraviolet light (tanning beds and sunlamps) and to wear protective clothing, sunglasses, and sunscreen. Tretinoin may make your skin sensitive to sunlight or ultraviolet light.
• You should know that weather extremes, such as wind and cold, may be particularly irritating.

Apply the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not apply extra cream, lotion, or gel to make up for a missed dose.

Tretinoin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• Warmth or slight stinging of the skin
• Lightening or darkening of the skin
• Red, scaling skin
• Increase in acne sores
• Swelling, blistering, or crusting of the skin
• Dryness, pain, burning, stinging, peeling, redness, or flaky skin at the treatment area

Some side effects can be serious. If you experience any of these symptoms call your doctor immediately:

• Itching
• Hives
• Pain or discomfort at the treatment area

Tretinoin may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not allow the medication to freeze.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

If someone swallows tretinoin, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Keep all appointments with your doctor.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.