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Acne is a chronic, self-limiting inflammatory disease of pilosebaceous unit. It is multifactorial, of which Propioniobacterium acne and Sebum play an important role in etiopathogenesis.The aim of the study is to compare efficacy of Tretinoin and Adapalene in Acne Vulgaris and to compare the side effects of topical tretinoin and adapalene.Randomized prospective comparative clinical trial with sample size of 50 patients who are recruited from department of dermatology of MMCH&RI.Adapalene 0. 1% produced numerically greater lesion reduction than tretinoin 0. 04% for all lesion types. Thus, Adapalene was found superior to Tretinoin in reducing average number of lesions. Highest reduction in number of lesions with both topical retinoids was for comedones (p< 0. 001) followed by papules (pIn Patients who applied adapalene, most of them were reduced to grade 0 and grade I and only few were in grade II. Whereas in patients who applied tretinoin only few were reduced to grade 0 and many were in grade I and grade II. Side effects were more commonly seen in patient treated with topical Tretinoin than with topical Adapalene. Adapalene was better tolerated than tretinoin. Hence adapalene is a safe and effective in treatment of acne.

Background: Striae are linear atrophic depressions that form in areas of dermal damage in the skin. As on date, no consensus or protocol exists for the treatment of stria rubra. Topical retinoids, chemical peels, microdermabrasion, radiofrequency, photothermolysis, intense pulsed light and lasers are some of the modalities used. Aims and Objective: To compare the efficacy of various therapeutic modalities in striae rubra. Methods: This prospective cohort study comprised of a total of fifty patients from August-2012 to October-2013 in a tertiary care center in Western India, Gujarat having striae rubra. They were randomly divided into five groups of ten patients each. Patients were evaluated on the basis of visual assessment, both by doctor as well as the patient. Group I was given topical tretinoin (0.1% w/w) gel applied once at night, Group II-microdermabrasion (MDA) combined with trichloroacetic acid (TCA) (30%) peel, Group III-mesotherapy, Group IV-Q-switched Nd: YAG laser, and Group V-combination treatment of microdermabrasion, salicylic acid peel and retinol (yellow) peel. Patients were treated at an interval of 15 days for 2 months and then at monthly intervals. Objective assessment was done at 2nd month, 6th month, and at the end of 1st year. Results: Patients in Group I treated with topical tretinoin showed the least response with 80% (8) of them showing minimal clinical improvement (0–25%) as compared to patients in Group V in which 60% (6) patients showed moderate clinical improvement (50–75%). While majority of the patients in Group II, III, and IV showed mild clinical improvement (25–50%). Conclusions: Striae rubra is a common cause of concern for adolescent population. Combination treatment with microdermabrasion, salicylic acid and retinol yellow peel gave superior results as compared to other therapeutic options. Mild to moderate improvement was seen with Nd: YAG laser, mesotherapy and MDA + TCA whereas minimal improvement were seen with topical tretinoin.

Porokeratotic Eccrine Ostial and Dermal Duct Nevus (PEODDN) is a rare disorder of keratinization characterized by the presence of cornoid lamellae and association with eccrine sweat ducts. These lesions are usually benign and asymptomatic, so treatment is often for cosmetic purposes. Current therapies for PEODDN are either insufficient or impractical. We present a case of PEODDN treated with topical tretinoin 0.05% cream and 5-fluorouracil 5% cream with the hopes of providing an efficacious, financially relevant, and well-tolerated treatment regime for PEODDN. The combination of topical tretinoin and 5-fluorouracil did not provide substantial improvement in the lesions of a patient treated with this therapy for 6 weeks, and further studies are needed to identify an efficacious treatment for PEODDN that is both well-tolerated and economically feasible for patients with this condition.

Dyer et al. (this issue) assess the risk of new basal cell carcinoma (BCC) in the Veterans Affairs topical tretinoin chemoprevention trial, which included individuals with a history of at least two prior keratinocyte carcinomas. In addition to known risk factors for a future BCC, such as number of prior BCCs, a history of eczema and lower education levels were also associated with greater risk.

Large-cell acanthoma is an asymptomatic, slightly keratotic, usually hyperpigmented epidermal lesion that is mostly seen in the sun-exposed skin of middle-aged or elderly people. It is characterized by extraordinarily large keratinocytes that can reach up to twice their normal size without a change in the nucleus/cytoplasm ratio. Here, we describe a chronic case of large-cell acanthoma that involved the whole upper eyelid of a 67-year-old man for at least 15 years. The lesion was almost depigmented and demonstrated altered consistency of the eyelid, causing lax and folded skin. The lesion responded to treatment with topical tretinoin and urea. This case verifies the benign character of large-cell acanthoma and demonstrates how it may have atypical presentations. Copyright (C) 2012, Taiwanese Dermatological Association. Published by Elsevier Taiwan LLC. All rights reserved.

First described in 1968 by Hitch and Lund. Disseminated and Recurrent infundibulofolliculitis (DRIF) is an uncommon eruption characterized by recurrent, pruritic follicular papules commonly seen on the trunk and proximal extremities. Rarely limited to the neck. It is much more common in black population but has also been reported in other ethnicities including Caucasians. Its etiology has constantly been debated with a few authors describing it as a variant of atopic dermatitis while others have refuted the same as a family history of atopy is not present. Various others have classified DRIF as variants of follicular eczema, along with lichen spinulosus and juxtaclavicular beaded lines. Its treatment also varies with different authors claiming response to steroids, isotretinoin, UVA therapy, keratolytics and tetracyclines. We describe a case of localized infundibulofolliculitis of the neck diagnosed in a 21 year old female who was successfully treated with a course of topical tretinoin 0.025%. The presenting history, clinical findings, biopsy results and available literature are reviewed.

This study was done in the outpatient department of Rajshahi Medical College Hospital from January 2004 to December 2005. In this study the efficacy of topical tretinoin, benzoyl peroxide and oral tetracycline was studied in 50 patients. Forty five patients completed the course of treatment and 5 patients were defaulter. Complete remission was seen in 32 (71.11%), marked improvement in 08 (17.78%) and good response in 05 (11.11%) patients. Application of topical tretinoin cream (0.05%) in the evening, benzoyl peroxide cream (5%) in the morning and oral tetracycline (500 mg bd) before meal was found very effective, safe and cheap in the treatment of comedonal, pustular and pustulo-nodular acne vulgaris. doi: 10.3329/taj.v19i1.3161 TAJ 2006; 19(1): 10-12

Hypopigmented macules are frequently observed in the photodamaged skin of elderly people. We undertook to study and treat 2 types of hypomelanosis of photoaged skin. These lesions were: 1) idiopathic guttate hypomelanosis; and 2) macular hypomelanosis. Comparative studies included: 1) high-resolution photography using parallel polarized light, ultra-violet (UVA) and epiluminescence; 2) Silflo replicas for microtopography; and 3) suction device (Cutometer) for elasticity. Macular hypomelanosis was distinguishable from idiopathic guttate hypomelanosis because the macules were less white and less well demarcated. Glyphic markings were essentially absent in macular hypomelanosis, but variably effaced in idiopathic guttate hypomelanosis. Distensibility of the macules was characteristically low in proportion to the loss of glyphic markings. The chief histologic finding was the absence of melanin in basal keratinocytes. Macular hypomelanosis and idiopathic guttate hypomelanosis are probably related disorders along a spectrum of depigmentation. Treatment with tretinoin for 4 months restored the elasticity, the glyphic markings, with a partial restoration of pigmentation.

Colloid milium is a degenerative process that is characterized clinically by the development of translucent, yellow, 1-2 mm papules located in photoexposed areas. Histologically, deposits of a colloid substance are seen in the papillary dermis. We present two cases of this infrequent pathology in two male patients, who had been subjected to intense sun exposure because of their work. We initiated treatment with photoprotective creams and topical tretinoin, with little clinical improvement.

Fifteen middle aged or elderly patients with chronic solar damage of the skin, eight patients with melasma and three patients with xeroderma pigmentosum were treated with topical tretinoin for 6 months. There was a significant improvement in fine surface lines in periorbital region, but no significant improvement was observed in deep furrows. No significant change was induced in melasma despite the improvement in smoothness of the skin surface. Global improvement was also seen in one patient with xeroderma pigmentosum. With regard to the functions of the stratum corneum that was assessed on the flexor surface of the forearms, values of water content as well as transepidermal water loss were found to increase one month after start of the application of tretinoin cream. On the other hand, there was no significant change in the amino acid content of the stratum corneum when measured after 4 months of the treatment. It is concluded that tretinoin cream is capable of partly reversing fine surface lines in photodamaged facial skin of the Japanese. However the irritation induced by 0.1% tretinoin cream was unexpectedly severe in the Japanese as compared to that reported in Caucasians.

A 53-year-old man presented with asymptomatic, hyperkeratotic papules and hyperpigmented macules of the face and upper extremities. Treatment was initiated with topical tretinoin and intralesional glucocorticoids. Acquired perforating disorder is a disorder of keratinization that is associated with diabetes mellitus and uremia. Classic presentation involves hyperkeratotic papules with a central core, which occur most frequently on the lower extremities. Treatment includes topical tretinoin, glucocorticoids, keratolytics, systemic retinoids and glucocorticoids, and ultraviolet B phototherapy.

We used information from the Group Health Cooperative of Puget Sound, Washington, USA, to evaluate the risk of birth defects in mothers exposed to topical tretinoin--a retinoid preparation used to treat acne--in the first trimester of pregnancy. We identified 215 women who delivered live or stillborn infants at Group Health Cooperative hospitals and who were exposed to topical tretinoin early in pregnancy, and 430 age-matched nonexposed women who delivered live or stillborn infants at the same hospitals. The prevalence of major anomalies among babies born to the exposed women was 1.9% and among babies born to the nonexposed women was 2.6%. The relative risk estimate for having a baby with a major congenital anomaly for exposed versus nonexposed women was 0.7 (95% CI 0.2-2.3). We conclude that topical tretinoin is not associated with an increased risk for major congenital disorders.

Background: There have been various controversial reports regarding the efficacy of topical agents in topical therapy of alopecia areata. Aim: The study aims to find out the effective ones among the readily available ones for a dermatologist. Materials and Methods: Eighty patients were chosen from the skin OPD of Bankura Sammilani Medical College, Bankura, West Bengal, after evaluating the exclusion criterions. Treatments were continued for 3 month period and a follow up after further 3 months. After dividing them into four groups-group-I (topical steroids), group-II (topical tretinoin 0.05%) group-III (dithranol paste 0.25%), and group-IV (white soft petrolatum jelly)-patients were evaluated. Results: Seventy percent of group-I, 55% of group-II, 35% of group-III, and 20% of the control group (white soft petrolatum jelly) responded favorably. Side effects in the form of dermatitis and hyperpigmentation were seen in group-III. However, no patient discontinued from the study. Conclusion: We conclude that both topical steroids and tretinoin were fairly effective in limited variant of alopecia areata.

SUMMARY The effect of o-1 % tretinoin cream for the treatment of photoageing was studied in a doubleblind, placebo-controlled trial. All patients applied tretinoin cream to one forearm and the vehicle cream to the other, and half of the patients also applied tretinoin cream to the face and the other half used the vehicle cream. Tretinoin treatment produced an improvement in the signs of extrinsic ageing conipared with the vehicle-treated areas. Fine wrinkling was improved most, although coarse wrinkling, brown spots, tactile roughness and overall skin colour also showed clear improvement. The majority of lentigines and sun-induced freckles showed some reduction in coloration with extended treatment. It is important when using tretinoin that the treatment procedure is carefully explained to the patients and that they are warned about a retinoid reaction. It should be stressed that improvement is gradual and that regular application of the cream must continue even after improvement has been achieved. Patients should be assured that there is no evidence of carcinogenicity in humans. Although no teratogenic effects of tretinoin have been reported when applied topically, it is not advisable to use the cream when trying to conceive or when pregnant. Tretinoin (all-rra«5-retinoic acid) has been used topically for the treatment of acne for the last two decades. More recently, it has been successfully tested and prescribed for the reversal of photoageing ^••^ but, in order to achieve significant improvement using topical tretinoin, patients must be carefully educated in how to apply the medication and on the degree of improvement that they can expect. An overview of the use of topical tretinoin in photoageing is presented and how patients should be instructed on the proper use of this medication is considered.

Tretinoin (0.1% Retin-A cream) was topically applied to human cadaver skin in vitro using Franz diffusion chambers. The photo-isomerization of tretinoin and retinoic acid percutaneous absorption in the absence of metabolic activity were assessed with and without ambient light exposure to the skin. Using HPLC, UV, and GC/MSD, a retinoid exhibiting identical chromatographic and spectral characteristics of isotretinoin was observed in the samples from the skin exposed to light, but was virtually absent in the skin samples maintained in the dark. From a single topical application of tretinoin, isotretinoin was as abundent as tretinoin in the chamber receiver solution, dermis, epidermis, and on the skin surface at 24 h after topical application. The data suggest the possibility that isotretinoin may have an important role in the pharmacology of topically applied tretinoin.

Dysplasia of the uterine cervix is a recognized preneoplastic condition. Because of the observed ability of retinoids to reverse other dysplastic conditions in vitro and in vivo, a number of clinical studies have been carried out of the effect of these agents on cervical dysplasia, with the object of developing a means of chemoprevention of cervical malignancies in women at risk. We have conducted phase I and II trials of topical tretinoin (retinoic acid and Retin-A) delivered by means of a cervical cap and inert collagen sponge system. The results of these studies warranted a phase III trial, which is now underway. The outcome of the latter investigation will have important implications, not only for the management of patients with cervical dysplasia but also for therapeutic approaches to other precancerous conditions.