Tretinoin Post-Bariatric Surgery Use: What Clinicians and Patients Need to Know

Does bariatric surgery change how topical tretinoin works?

Tretinoin is spread on the skin, so it does not pass through the digestive tract the way a tablet does. Whether bariatric surgery affects its absorption or effects has not been studied in the material cited here.

The Renova label states that no percutaneous absorption study was conducted with Renova 0.02% in human volunteers [1]. For a separate 0.05% oil-in-water tretinoin cream, absorption was less than 2% of the applied dose in seven healthy men after a single application and in seven healthy men after 28 days of daily applications [1]. The label also reports that absorption from various topical tretinoin formulations ranged from 1% to 31% of the applied dose, depending on whether the product was applied to healthy skin or dermatitic skin [1].

The Renova label says to apply a small, pearl-sized amount once each evening to lightly cover the affected facial area, after gently washing with a mild soap, patting the skin dry and waiting 20 to 30 minutes [1].

Irritation and sensitive skin

The Renova label calls the product a dermal irritant [1]. In double-blind vehicle-controlled studies of 339 patients applying Renova 0.02% to the face, almost all reported at least one local reaction such as peeling, dry skin, burning, stinging, redness or itching; in 32% of all study patients, skin irritation was severe, led to temporary discontinuation, or led to use of a mild topical corticosteroid, and about 4% discontinued because of adverse reactions [1].

The label says to keep Renova out of the eyes, mouth, angles of the nose and mucous membranes [1]. It also says tretinoin has been reported to cause severe irritation on eczematous skin and should be used only with caution in that condition [1]. Applying more medication than recommended has not been shown to lead to more rapid or better results and may cause marked redness, peeling or discomfort [1].

Sun and photosensitizing drugs

The Renova label says exposure to sunlight, including sunlamps, should be avoided or minimized during use because of heightened sunburn susceptibility, and that patients who are sunburned should not use the product until fully recovered [1]. It advises sunscreens with a minimum SPF of 15 and protective clothing, and says people with considerable sun exposure through work, and those with inherent sensitivity to sunlight, should exercise caution [1].

The label also says Renova should not be administered to patients taking drugs known to be photosensitizers, naming thiazides, tetracyclines, fluoroquinolones, phenothiazines and sulfonamides, because of possible augmented phototoxicity [1]. Doxycycline is a tetracycline.