Tretinoin, also known as 

all-trans retinoic acid (ATRA), is a medication used for the

treatment of acne and acute promyelocytic leukemia.[5][6][7] For acne, it is applied to the

skin as a cream, gel or ointment. [7] For leukemia, it is taken by mouth for up to three

months.[5] Topical tretinoin is also the most extensively investigated retinoid therapy

for photoaging.[8]

Common side effects when used as a cream are limited to the skin and include skin

redness, peeling, and sun sensitivity. [7] When used by mouth, side effects

include shortness of breath, headache, numbness, depression, skin dryness, itchiness,

hair loss, vomiting, muscle pains, and vision changes. [5] Other severe side effects

include high white blood cell counts and blood clots.[5] Use during pregnancy is

contraindicated due to the risk of birth defects. [5][1] It is in the retinoid family of

medications.[6]

Tretinoin was patented in 1957, and approved for medical use in 1962. [9] It is on

the World Health Organization's List of Essential Medicines.[10] Tretinoin is available as

a generic medication.[11] In 2019, it was the 244th most commonly prescribed medication

in the United States, with more than 1 million prescriptions.

Photoaging[edit]

Photoaging is premature skin aging resulting from prolonged and repeated exposure to

solar radiation. Features of photoaging include fine and coarse wrinkles, change in skin

pigmentation, and loss of elasticity. In human skin, topical retinoids increase collagen

production, induce epidermal hyperplasia, and

decrease keratinocyte and melanocyte atypia. Topical tretinoin is the most extensively

investigated retinoid therapy for photoaging. [22] Topical tretinoin can be used for mild to

severe photoaging in people of all skin types. Several weeks or months of use are

typically required before improvement is appreciated. The benefits of topical tretinoin

are lost upon discontinuation. Although it has only been studied for a duration of two

years, it may be continued indefinitely. A long-term maintenance regimen with a lower

concentration or less frequent application may be an alternative to continued use

The oral form of the drug has boxed warnings concerning the risks of retinoic acid

syndrome and leukocytosis.[3]

Other significant side effects include a risk of thrombosis, benign intracranial

hypertension in children, high lipids (hypercholesterolemia and/or hypertriglyceridemia),

and liver damage.[3]

There are many significant side effects from this drug that include malaise (66%),

shivering (63%), hemorrhage (60%), infections (58%), peripheral edema (52%), pain

(37%), chest discomfort (32%), edema (29%), disseminated intravascular coagulation

(26%), weight increase (23%), injection site reactions (17%), anorexia (17%), weight

decrease (17%), and myalgia (14%).[3]

Respiratory side effects usually signify retinoic acid syndrome, and include upper

respiratory tract disorders (63%), dyspnea (60%), respiratory insufficiency (26%),

pleural effusion (20%), pneumonia (14%), rales (14%), and expiratory wheezing (14%),

and many others at less than 10%.[3]

Around 23% of people taking the drug have reported earache or a feeling of fullness in

their ears.[3]

Gastrointestinal disorders include bleeding (34%), abdominal pain (31%), diarrhea

(23%), constipation (17%), dyspepsia (14%), and swollen belly (11%) and many others

at less than 10%.[3]

In the cardiovascular system, side effects include arrhythmias (23%), flushing (23%),

hypotension (14%), hypertension (11%), phlebitis (11%), and cardiac failure (6%) and

for 3% of patients: cardiac arrest, myocardial infarction, enlarged heart, heart murmur,

ischemia, stroke, myocarditis, pericarditis, pulmonary hypertension, secondary

cardiomyopathy.[3]

In the nervous system, side effects include dizziness (20%), paresthesias (17%),

anxiety (17%), insomnia (14%), depression (14%), confusion (11%), and many others at

less than 10% frequency.[3]

In the urinary system, side effects include chronic kidney disease (11%) and several

others at less than 10% frequency