Tretinoin Restarting After Acute Illness: A Clinical Guide

Is there a restart schedule for tretinoin after illness?

The Renova label does not say how long to wait, how far to step down or how fast to rebuild frequency after a break [1]. The 12-week trial of tretinoin gel microsphere in acne did not test restarting either [2].

What the Renova label does address is skin that is already damaged or inflamed before the first application. Its label says patients with sunburn should not use it until fully recovered, that people with inherent sensitivity to sunlight should be especially careful, that tretinoin has been reported to cause severe irritation on eczematous skin, that it should not be used during pregnancy, and that it should not be used with drugs known to be photosensitizers [1].

What the Renova label says about damaged or irritated skin

• Sunburn. The label says patients with sunburn should not use Renova until fully recovered, because of heightened susceptibility to sunlight [1].
• Eczema. The label warns that tretinoin has been reported to cause severe irritation on eczematous skin [1].
• Irritation. The label 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 altogether [1].
• More is not better. The label says larger amounts than recommended have not been shown to give faster or better results, and marked redness, peeling or discomfort may occur [1].
• Sun. The label says exposure to sunlight, including sunlamps, should be avoided or minimized, with sunscreen of at least SPF 15 and protective clothing [1].

Does the formulation change the answer?

The Renova label covers one product, tretinoin cream 0.02%, an adjunct for fine facial wrinkles used with a skin care and sun avoidance program. It states the cream does not eliminate wrinkles, repair sun-damaged skin, reverse photoaging or restore a more youthful skin structure [1].

A separate 12-week double-blind trial compared tretinoin gel microsphere 0.1% with adapalene gel 0.1% in acne. It was not a comparison with another tretinoin product and not a restart study. Both drugs resolved acne lesions similarly, with a greater reduction in comedones at week 4 for tretinoin gel microsphere (P=0.047). The microsphere gel had more dryness and peeling at some visits, with comparable erythema, burning/stinging and itching [2].

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