Oralretinoids

• retinoids are a class of chemical compounds that are related chemically to vitamin A.

Retinoids (found in animal foods)

Carotenoids (found in plant foods)

• Retinoids are used in medicine, primarily due to the way they regulate epithelial cell growth.

Types3generations of retinoids:

• First generation retinoids: retinol, retinal, tretinoin (retinoic acid, Retin-A), isotretinoin, and alitretinoin.

• Second generation retinoids: etretinate and its metabolite acitretin.

• Third generation retinoids: tazarotene, bexarotene and Adapalene.

Function of retinoid

roles in vision

regulation of cell proliferation and

differentiation, growth of bone tissue,

immune function, and

activation of tumor suppressor genes.

Research is also being done into their ability to treat skin cancers

Skin condition use

acne

psoriasis

wrinkles

age spots

Action

• Retinoids work to reduce the amount of oil secreted through the glands lessen SEBUM production.

• reduce the hypercornification (the excessive production of skin cells in the lining of the follicle) of the pilosebaceous duct.

• do not have any antibacterial properties but appear to lessen the bacterial population

• Retinoids lessen the inflammation on the plugs in the skin pores. (These plugs are dead skin cells mixture, bacteria and sebum)

• Regular blood tests to check on liver function are very common.

Side Effects

• dry skin

• occasionally nosebleeds as a result of dry nasal mucosa.

• first month or so, oral retinoids may cause a temporary flare up of acne conditions

• Liver damage many doctors will recommend blood samples to be taken and examined before and during oral retinoid treatment.

• depression but no medical literature has agreed as to the risk.

• cause birth defects if women take the medicine while pregnant or on the drug when they become pregnant must use two effective methods of birth control.

precautions

• Do not apply astrin¬gents,

• drying agents,

• abrasive scrubs, or harsh soaps to your face while using the retinoid.

• Retinoids may make you more sensitive to sunlight. Apply a sunblock to your face before spend¬ing time in the sun.

Adapalene - Differin, is a synthetic topical retinoid

• acne and other skin-related diseases.

• Adapalene works by helping unclog blocked skin pores, and providing mild anti-inflammatory properties.

Tazarotene-Tazorac or Avagesynthetic topical retinoid

• help keep acne-prone follicles on the skin free of comedone plugs (blackheads and whiteheads)

• used to fight off the accelerated signs of aging due to unprotected exposure to the sun (photoaging).

Tretinoin-Retin-A and Renova, is a topical retinoid

• unclog skin follicles affected by acne.

• The drug can also be used to reduce the signs of photoaging, such as wrinkles and age spots.

Acitretin – Soriatane (oral retinoid)

• primarily used to treat Darier's disease and psoriasis,

• chemoprevention of skin cancer with transplant patients, according to the Skin Cancer Foundation.

Isotretinoin

• most potent retinoids available on the market,

• treatment of only the most severe cases of acne, such as acne cysts and nodul Isotretinoin

• addresses all the major causes of acne, including inflammation, bacterial infection, sebum oil production and blocked pores.

(trade name: Accutane)

ISOTRETINOIN:

• Isotretinoin is unique in that it controls acne for months, years, or permanently after the end of treatment.

• Four to five months of isotretinoin treatment usually lead to clearing of acne for 1 year or more after the medicine is stopped.

• All other internal acne-controlling medicines are antibacterial agents, which are effective only while they are used.

• Isotretinoin is not only considered the only known possible cure of acne in some patients, but was originally a chemotherapy treatment for certain cancers, such as leukemia

HOW DOES ISOTRETINOIN WORK?

• Isotretinoin decreases the amount of oil produced by the skin’s sebaceous (oil) glands.

• It may be as long as 3 months before you see improvement in your skin.

• There is no medicine we can add to speed isotretinoin’s action.

TREATMENT

• Isotretinoin works best when taken with food, so remember to take it at mealtime.

interaction

• Do not take vitamin A while being treated with isotretinoin; serious side effects may occur. Isotretinoin and vitamin A are closely related chemically. You should also stop any other acne treatment by mouth because antibiotics may interact with isotretinoin. You may continue to apply medicine to your face if you wish, but do not use tretinoin (Retin-A and other brands) while being treated with isotretinoin.

• Occasionally acne gets worse during the first month or two of treatmentside effects such as lip dryness begin before the acne starts to clear.

Side effects

• Isotretinoin is expensive and has many annoying side effects

• Isotretinoin comes with potentially serious fetal side effects if used or directly handled by pregnant womens.

• Except for birth defects isotretinoin is remarkably safe. Even massive overdoses cause only dry skin and headaches.

• .

• Isotretinoin may increase the level of triglycerides (fats) in the blood. Rarely, it may affect liver function.

• establish baseline blood chemistries before patients begin to take isotretinoin.

• After 4 to 6 weeks of isotretinoin treatment, the blood chemistry tests are repeated. If these tests are normal, further testing is not necessary.

• Depression is a rare side effect

precautions

• . During isotretinoin treatment, skin may be more easily injured vigorous physical exercise should be avoided.

• Consequently, defer wax-type hair removal and any facial cosmetic surgery or resurfacing procedure.

LONG-TERM RESULTS

• Isotretinoin is not a permanent cure for acne, although it often clears acne until nature clears your skin.

• One year after completion of a course of isotretinoin, four out of five persons will be free of acne.

• Three years after isotretinoin treatment, about three out of five persons will remain without acne.

• Should it become necessary, it is safe to take a second or a third course of isotretinoin, or take a short booster course of isotretinoin.

dosage

India as 5, 10, 20, 30, and 40 mg sofgel capsules 0.5-1.0 mg/kg body weight

The treatment is continued till a cumulative dose of 120-150 mg/kg has been achieved.

This typically may take 6-8 months.