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With sensible patient education, the multitude of benefits that topical retinoid therapy can provide may be enjoyed. Hopefully, retinoid therapy will heighten awareness of the detrimental effects, of sun exposure and motivate future generations to become "sun smart."
Topical retinoids provide a beneficial, novel way of treating a plethora of dermatologic disorders, in view of their ability to address numerous inflammatory and keratotic dermatoses. The utilization of topical retinoids is advantageous over systemic retinoids from a toxicologic perspective. Though often effective and beneficial, administration of systemic retinoids can be associated with disturbing, adverse reactions such as teratogenesis, pseudotumor cerebri, hepatotoxicity, elevated triglycerides, depression, alopecia, musculoskeletal symptoms, and altered night vision (Nurse Practitioner's Prescribing Reference [NPPR], 2003). With topical retinoids, the possibility of toxicity and side effects are minimized, while still contributing to a favorable localized efficacy (Verschoore, Bouclier, Czernielewski, & Hensby, 1993). The purpose of this article is to explore current, state of the art dermatologic practices regarding the use of topical retinoids. Topical retinoids can provide an extensive spectrum of benefits, addressing multiple dermatologic issues at once. Patient support and education are essential during retinoid therapy to ensure successful clinical outcomes (Baumann, 2003). We must empower our patients with the knowledge of risks, benefits, reasonable expectations, and the importance of becoming "sun smart."
How Do Retinoids Work?
Topical retinoids (for example, tretinoin) and retinoid analogues (for example, adapalene and tazarotene) help normalize hyperkeratinization and have demonstrated significant anti-inflammatory effects. Retinoids are potent agents that can normalize abnormal growth and differentiation in keratinocytes (American Academy of Dermatology [AAD], 2003). Topical retinoids also demonstrate inhibition of various immune factors, including the activity of leukocytes, the release of pro-inflammatory cytokines and other mediators, and the expression of transcription factors and toll receptors involved in immunomodulation (Wolf, 2002). These various mechanisms may be advantageous to clinicians in managing numerous inflammatory and keratotic dermatoses. Topical retinoids have the potential of indirectly reducing the risk of antibiotic resistance by controlling and maintaining remission of inflammatory and noninflammatory lesions (Rizova, Pagnoni, Stoudemayer, Poncet, & Kligman, 2001). All-trans retinol is considered to be a parent form of vitamin A and the addition of this compound in over-the-counter (OTC) products is not considered to be a drug. Due to substantial structural...