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Acne is a chronic inflammatory skin condition. Today, it is one of the most common dermatological problems. Modern dermatology offers various treatment methods, many of which are based on the use of vitamin A. To ensure that treatment is as effective and safe as possible, it is important to understand what retinoids are and how they affect the body.
What Are Retinoids and How Do They Work?
Retinoids are a group of natural and synthetic compounds that are forms or analogues of vitamin A. They have the unique ability to bind to specific nuclear receptors in skin cells and regulate the processes of cell division, differentiation, and renewal. Patients need to understand how retinoids work at the tissue level:- Normalization of keratinization. These medications prevent dead skin cells from sticking together inside hair follicles, helping prevent the formation of comedones (blackheads and closed comedones).
- Reduction of sebum production. The active ingredients suppress the activity and reduce the size of sebaceous glands, depriving Cutibacterium acnes bacteria of their nutrient-rich environment.
- Anti-inflammatory effect. These medications suppress the production of inflammatory mediators, quickly reducing redness and painful acne lesions.
- Accelerated regeneration. Epidermal renewal is stimulated, helping improve skin texture and eliminate post-inflammatory marks more quickly.
Types of Retinoids: Topical Application and Systemic Therapy
Depending on the method of administration and formulation, retinoids are divided into two main categories: topical (external use) and systemic (oral administration).Topical Treatments
This group includes creams, gels, and lotions applied directly to the skin of the face or body. Topical products contain active ingredients such as adapalene, tretinoin, isotretinoin, or tazarotene. They are applied externally and act locally in the upper layers of the skin. These medications are effective for mild acne and for moderate forms when used as part of combination therapy. Topical treatments help minimize systemic effects on the body while providing a significant therapeutic effect on the skin.Systemic Medications
Systemic retinoids are powerful medications based on isotretinoin, available in capsule form for oral administration. They have a comprehensive effect on the body, targeting all four mechanisms involved in acne development simultaneously. The use of these medications requires strict medical supervision, regular laboratory testing, and careful adherence to the dosages prescribed by a dermatologist.For What Severity of Acne Are Retinoids Prescribed?
The choice of treatment always depends on the severity of the condition, the presence of scarring, and the patient's emotional well-being. When determining which severity of acne requires retinoids, specialists follow international clinical guidelines:- mild acne: only topical retinoids are prescribed, either as monotherapy or in combination with benzoyl peroxide or antibacterial agents;
- moderate acne: combinations of topical treatments are used. If standard topical therapy does not produce results within 3–4 months or scarring develops, switching to oral capsules may be considered;
- severe and nodulocystic acne: systemic retinoids are generally the preferred treatment option. They can help achieve long-lasting remission even in cases involving deep skin lesions.
What Should You Know Before Starting Treatment?
Retinoids for acne should only be prescribed by a qualified dermatologist. Attempting self-treatment can lead to serious health consequences.Main Contraindications
Before starting treatment, the doctor carefully checks for contraindications, including:- pregnancy and breastfeeding (retinoids, especially systemic forms, have strong teratogenic effects and can cause severe fetal developmental abnormalities);
- planning pregnancy in the near future;
- severe liver and kidney failure;
- hypervitaminosis A;
- elevated blood lipid levels;
- childhood (systemic forms are generally not recommended for children under 12 years of age).
Side Effects and the Adaptation Period
When taking or applying medications from this group, patients should be prepared for certain side effects that may appear during the first weeks of treatment:- Retinoid dermatitis. Peeling, dryness, redness, and increased skin sensitivity. This is a common adaptation reaction that can be managed with appropriate moisturizing skincare.
- Xerosis (dryness of the skin and mucous membranes). Pronounced dryness of the lips (cheilitis), nasal mucosa, and eyes.
- Initial acne flare-up. During the first 2–4 weeks, the number of acne lesions may temporarily increase. This is a natural process associated with the clearing of deep comedones.
- Increased photosensitivity. The skin becomes highly sensitive to ultraviolet radiation, making daily use of sunscreen with SPF 30–50 an essential part of protection.
Rules for Successful Treatment
To make the treatment course as comfortable and effective as possible, follow these simple recommendations:- do not stop treatment on your own at the first signs of improvement — reaching the cumulative dose is important;
- eliminate harsh scrubs, alcohol-based lotions, and exfoliating acids from your daily skincare routine;
- undergo blood chemistry tests as prescribed by your doctor to monitor liver function and lipid levels;
- women of reproductive age must use reliable contraception while taking systemic retinoids and for one month after discontinuing treatment.
FAQ: Frequently Asked Questions
1. Can Retinoids Be Used During Summer?
Yes, retinoids can be used during summer, provided that sunscreen with a high protection factor (SPF 50+) is applied consistently and correctly, and direct sun exposure and tanning are avoided.2. How Long Does a Course of Systemic Retinoid Treatment Last?
The average duration of systemic retinoid therapy is 6 to 9 months. The exact treatment period is determined individually by a dermatologist based on the patient's body weight and the time required to reach the cumulative dose.3. How Soon After Completing Treatment Can Pregnancy Be Planned?
Pregnancy can be planned one month after completing a course of isotretinoin treatment. During this period, the active substance is completely eliminated from the body.
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