Tretinoin for Adults 65+: School, Work, and Daily Activity Considerations

Can you keep working, studying and going out on tretinoin?

The reactions the Renova label describes are mostly local skin reactions. In the double-blind, vehicle-controlled Renova studies of 339 patients, almost all reported one or more local reactions such as peeling, dry skin, burning, stinging, redness and itching, and the label says adverse reactions associated with use were limited primarily to the skin [1].

The routine itself is short. The Renova label directs once-daily evening use: gently wash the face with a mild soap, pat the skin dry, wait 20 to 30 minutes, then apply a pearl-sized amount (about 1/4 inch across) to cover the entire affected area lightly, keeping it away from the eyes, ears, nostrils and mouth [1]. Since the cream goes on in the evening, the daytime precautions below are the ones that apply during work and outings.

Sun on the job, in the garden and at the weekend

The Renova label says exposure to sunlight, including sunlamps, should be avoided or minimized during use because of heightened sunburn susceptibility, and that patients should use sunscreens with a minimum SPF of 15 and protective clothing [1]. It adds that patients who may have considerable sun exposure because of their occupation, and those with inherent sensitivity to sunlight, should exercise caution when using the product [1]. People with sunburn should not use it until fully recovered [1].

Photosensitizing medicines and other products

The Renova label says the product should not be administered if the patient is also taking drugs known to be photosensitizers. It names thiazides, tetracyclines, fluoroquinolones, phenothiazines and sulfonamides, because of the possibility of augmented phototoxicity [1].

The label's other exclusions are skin-related: it says not to use Renova if the patient is sunburned, has eczema or another chronic skin condition of the face, or is inherently sensitive to sunlight [1]. Its drug interactions section says other topical medications, medicated or abrasive soaps, shampoos, cleansers, cosmetics with a strong drying effect, products with high concentrations of alcohol, astringents, spices or lime, permanent wave solutions, electrolysis, hair depilatories and waxes may increase irritation and should be used with caution [1].

What shows up on your face

The Renova label reports how often irritation was bad enough to interrupt treatment. In its vehicle-controlled studies of 339 patients, 32% had skin irritation that was severe, led to temporary discontinuation, or led to use of a mild topical corticosteroid. About 7% of patients using Renova needed short-term mild topical corticosteroid use, compared with less than 1% of controls, and about 4% discontinued because of adverse reactions [1].

The label also says larger amounts of medication than recommended have not been shown to lead to more rapid or better results, and marked redness, peeling or discomfort may occur [1]. It notes that tretinoin has been reported to cause severe irritation on eczematous skin [1].

Does a stronger cream work better?

Not in the comparison that was run, which used strengths other than Renova 0.02%. In a 48-week double-blind trial, 99 patients with photoaged facial skin were assigned to 0.1% tretinoin cream (32 patients), 0.025% (35) or vehicle (32). Both strengths produced significant overall improvement in photoaging compared with vehicle, with no clinically or statistically significant difference in efficacy between the two concentrations, while erythema and scaling were significantly greater with 0.1% [2].

A 24-week study of 251 subjects with mild to moderate photodamage, using 0.05% and 0.01% emollient creams, found overall improvement in 79% of those using 0.05% tretinoin compared with 48% of vehicle-treated subjects. Erythema, peeling and stinging were usually mild and well tolerated [3].

What this product is approved for, and who the trials skipped

The label details on this page are those of Renova (tretinoin cream) 0.02%. Renova is indicated only as an adjunctive agent, alongside a comprehensive skin care and sunlight avoidance program that includes sunscreens of at least SPF 15 and protective clothing, for mitigation (palliation) of fine facial wrinkles. Its label states that it does not eliminate wrinkles, repair sun-damaged skin, reverse photoaging or restore more youthful or younger skin [1]. It has not demonstrated a mitigating effect on coarse or deep wrinkling, tactile roughness, mottled hyperpigmentation, lentigines, telangiectasia, skin laxity, keratinocytic atypia, melanocytic atypia or dermal elastosis [1].

Patients with visible actinic keratosis and patients with a history of skin cancer were excluded from the Renova trials, so safety in those populations is not known at this time [1]. Neither the safety nor the effectiveness of Renova for the prevention or treatment of actinic keratoses or skin neoplasms has been established, and neither the safety nor the efficacy of daily use beyond 52 weeks has been established [1].

If irritation starts disrupting your week

The Renova label treats irritation as a matter of degree. It says that, if the degree of local irritation warrants, patients should be directed to use less medication, decrease the frequency of application, discontinue use temporarily, or discontinue use altogether and consider additional appropriate therapy [1]. Topical use may cause severe local erythema, pruritus, burning, stinging and peeling at the site of application [1]. The label's only listed contraindication is a history of sensitivity reactions to any of its components, and it says the product should be discontinued if hypersensitivity to any of its ingredients is noted [1].