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Tretinoin  is retinoic acid in pharmaceutical form. One of several retinoids, it is the carboxylic acid form of vitamin A and is also known as all-trans retinoic acid or ATRA. It is a first generation topical retinoid commonly used to treat acne vulgaris and keratosis pilaris. It is available as a cream or gel (brand names Aberela, Airol, A-Ret, Atralin, Avita, Retacnyl, Refissa, Renova, Retin-A, Retino-A, ReTrieve, or Stieva-A). The most common strengths are 0.025%, 0.05% and 0.1%. It is also used to treat acute promyelocytic leukemia (APL), under the brand name Vesanoid. It is also available as a generic. Its isomer, isotretinoin, is also an acne drug.

Side effects

In dermatological use

When used, dryness or increased sensitivity to sunlight of the affected skin may occur. More sensitive patients may also experience redness, scaling, itching, and burning A gradual increase in the frequency and amount of tretinoin application is best, as this allows one's skin to adequately adjust to the drug. Patients should be careful to follow their physician's recommendations when beginning a round of treatment.

As this product may cause irritation, it may indirectly increase sun sensitivity and fragility of the skin Patients who are using the drug should apply moisturizer and sunscreen to reduce the chance of developing sunburn while using tretinoin. Additionally, patients using tretinoin should be cautious when simultaneously using other topical medications that contain salicylic acid, resorcinol, or sulfur because these medications may potentiate the drying and possibly irritating effects of tretinoin. Topical tretinoin should be avoided during pregnancy because its use has been linked to birth defects in several case reports.

In leukemia use

There is a unique complication of retinoic acid syndrome in patients with acute promyelocytic leukemia. This is associated with the development of dyspnea, fever, weight gain, peripheral edema and is treated with dexamethasone. The etiology of retinoic acid syndrome has been attributed to capillary leak syndrome from cytokine release from the differentiating promyelocytes.

Teratogenicity

It is a teratogen, and therefore can cause birth defects and tests have shown increases in fetal skull abnormalities in rats. Women who are or may be pregnant, or who are seeking to become pregnant, are therefore warned against using it This teratogenic effect is caused by the interference of the exogenous retinoic acid with endogenous retinoic acid signaling, which plays a role in patterning the developing embryo.