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Topical tretinoin (topical all-trans retinoic acid): Drug information

Topical tretinoin (topical all-trans retinoic acid): Drug information
(For additional information see "Topical tretinoin (topical all-trans retinoic acid): Patient drug information" and see "Topical tretinoin (topical all-trans retinoic acid): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Altreno;
  • Atralin;
  • Avita;
  • Refissa;
  • Renova;
  • Renova Pump;
  • Retin-A;
  • Retin-A Micro;
  • Retin-A Micro Pump
Brand Names: Canada
  • Retin-A;
  • Retin-A Micro;
  • Stieva-A
Pharmacologic Category
  • Acne Products;
  • Retinoic Acid Derivative;
  • Topical Skin Product, Acne
Dosing: Adult
Acne vulgaris

Acne vulgaris: Topical: Apply to acne lesions once daily before bedtime or in the evening. Consider starting with the lowest possible concentration to minimize skin irritation and increase potency as tolerated. For moderate to severe acne, may be used as part of an appropriate combination regimen. Avoid simultaneous application with benzoyl peroxide (may reduce tretinoin efficacy) (Graber 2022).

Palliation of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin

Palliation of fine wrinkles (Refissa/Renova), mottled hyperpigmentation, and tactile roughness of facial skin (Refissa): Topical: Apply a pea-sized amount of cream to entire face once daily in the evening or before bedtime.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric

(For additional information see "Topical tretinoin (topical all-trans retinoic acid): Pediatric drug information")

Acne vulgaris: Children ≥8 years and Adolescents: Topical: Apply to affected areas once daily. Begin therapy with a weaker formulation of tretinoin and increase the concentration as tolerated; if stinging or irritation develop, decrease frequency of application. Approved ages varies by product; see individual product labeling. Guidelines suggest that topical retinoids may be used as part of a therapeutic regimen for all types and severity of acne in children and adolescents; however, specific data for each tretinoin product formulation may not be available (Eichenfield 2013).

Product specific:

Altreno (Lotion 0.05%): Children ≥9 years and Adolescents: Topical: Apply to affected areas once daily.

Atralin (Gel 0.05%): Children ≥10 years and Adolescents: Topical: Apply once daily to acne lesions before bedtime.

Retin-A (Cream 0.025%, 0.05%, or 0.1%; Gel 0.01% or 0.025%), Tretin-X (Cream 0.025%, 0.0375%, 0.05%, 0.075%, or 0.1%): Children ≥12 years and Adolescents: Topical: Apply once daily to acne lesions before bedtime or in the evening.

Retin-A Micro:

Children 8 to <12 years: Limited data available: Gel (0.04%): Topical: Apply once daily to acne lesions before bedtime or in the evening (Eichenfield 2010; Eichenfield 2012).

Children ≥12 years and Adolescents: Gel (0.04%, 0.06%, 0.08%, or 0.1%): Topical: Apply once daily to acne lesions before bedtime or in the evening.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however dosage adjustment unlikely needed due to low systemic absorption.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however dosage adjustment unlikely needed due to low systemic absorption.

Dosing: Older Adult

Refer to adult dosing; safety/efficacy of Retin-A has not been established in patients >65 years of age; safety/efficacy of Refissa has not been established in patients >50 years of age; safety/efficacy of Renova has not been established in patients >71 years of age.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Avita: 0.025% (20 g, 45 g)

Refissa: 0.05% (20 g, 40 g) [contains edetate (edta) disodium, methylparaben, propylparaben]

Renova: 0.02% (20 g, 40 g, 60 g) [contains benzyl alcohol, cetyl alcohol, edetate (edta) disodium, methylparaben, propylparaben]

Renova Pump: 0.02% (44 g) [contains benzyl alcohol, cetyl alcohol, edetate (edta) disodium, methylparaben, propylparaben]

Retin-A: 0.025% (20 g, 45 g); 0.05% (20 g, 45 g); 0.1% (20 g, 45 g)

Generic: 0.025% (20 g, 45 g); 0.05% (20 g, 40 g, 45 g); 0.1% (20 g, 45 g)

Gel, External:

Atralin: 0.05% (45 g) [contains benzyl alcohol, butylparaben, ethylparaben, fish collagen hydrolyzates, isobutylparaben, methylparaben, propylparaben, trolamine (triethanolamine)]

Avita: 0.025% (20 g, 45 g)

Retin-A: 0.01% (15 g, 45 g); 0.025% (15 g, 45 g)

Retin-A Micro: 0.04% (20 g, 45 g); 0.1% (20 g, 45 g) [contains benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)]

Retin-A Micro Pump: 0.04% (50 g) [contains benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)]

Retin-A Micro Pump: 0.06% (50 g) [contains benzyl alcohol, edetate (edta) disodium, propylene glycol, trolamine (triethanolamine)]

Retin-A Micro Pump: 0.08% (50 g); 0.1% (50 g) [contains benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)]

Generic: 0.01% (15 g, 45 g); 0.025% (15 g, 45 g); 0.04% (20 g, 45 g, 50 g); 0.05% (45 g); 0.1% (20 g, 45 g, 50 g)

Lotion, External:

Altreno: 0.05% (20 g, 45 g) [contains benzyl alcohol, methylparaben, trolamine (triethanolamine)]

Generic Equivalent Available: US

May be product dependent

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Retin-A: 0.01% (30 g); 0.025% (30 g); 0.05% (30 g); 0.1% (30 g)

Generic: 0.01% (25 g); 0.025% (25 g); 0.05% (25 g)

Gel, External:

Retin-A: 0.01% (30 g); 0.025% (30 g) [contains alcohol, usp]

Retin-A Micro: 0.04% (20 g, 45 g, 50 g); 0.1% (2 g, 20 g, 45 g, 50 g) [contains benzyl alcohol, disodium edta, propylene glycol, trolamine (triethanolamine)]

Generic: 0.01% (25 g); 0.025% (25 g); 0.05% (25 g)

Administration: Adult

For topical external use only; not for oral, ophthalmic, or intravaginal use. Prior to application, wash hands; gently wash face with a mild soap; pat dry and wait 20 to 30 minutes. Apply thin layer to affected area in the evening or before bedtime, avoiding eyes, ears, nostrils, and mouth. If stinging or irritation develop, temporarily discontinue or decrease frequency of application. Wash hands immediately after applying. Avoid use of products to the affected area that contain high concentrations of alcohol, astringents, or spices. Do not apply to sunburned skin. If combination topical therapy is required, consider separating applications (eg, one drug in the morning and the other in the evening or before bedtime).

Retin-A Micro: Avoid contact with lime peel and application area.

Administration: Pediatric

Topical: For external use only; not for oral, ophthalmic, or intravaginal use. Prior to application, wash hands; gently wash face with a mild soap; pat dry and wait 20 to 30 minutes. Apply thin layer to affected area in the evening or before bedtime, avoiding eyes, mouth, paranasal creases, and mucous membranes. If stinging or irritation develop, temporarily discontinue or decrease frequency of application. Wash hands immediately after applying. Avoid use of products to the affected area that contain high concentrations of alcohol, astringents, or spices. Do not apply to sunburned skin. If combination topical therapy is required, consider separating applications (eg, one drug in the morning and the other in the evening or before bedtime).

Retin-A Micro: Avoid contact with lime peel and application area.

Hazardous Drugs Handling Considerations

Hazardous agent (NIOSH 2016 [group 3]).

Use appropriate precautions for receiving, handling, administration, and disposal (NIOSH 2016). Gloves (single) should be worn during receiving, unpacking, and placing in storage.

NIOSH recommends double gloving, a protective gown, and (if liquid that could splash) eye/face protection for administration of a topical product; if there is potential for inhalation, respiratory protection is recommended (NIOSH 2016). Assess risk to determine appropriate containment strategy (USP-NF 2017).

Use: Labeled Indications

Acne vulgaris: Altreno, Atralin, Avita, Retin-A, Retin-A Micro, Stieva-A [Canadian product], Tretin-X, Vitamin-A Acid [Canadian product]: Treatment of acne vulgaris.

Palliation of fine wrinkles: Renova: Adjunctive treatment for mitigation (palliation) of fine wrinkles in patients who use comprehensive skin care and sun avoidance programs.

Palliation of fine wrinkles, mottled hyperpigmentation, and facial skin roughness: Refissa: Adjunctive treatment for mitigation (palliation) of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin in patients who do not achieve such palliation using comprehensive skin care and sun avoidance programs alone.

Medication Safety Issues
Sound-alike/look-alike issues:

Tretinoin may be confused with ISOtretinoin, Tenormin, triamcinolone, trientine

International issues:

Renova [U.S., Canada] may be confused with Remov brand name for nimesulide [Italy]

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Dermatologic: Stinging of the skin (21%), local dryness (4% to 16%), hypopigmentation (≤12%)

Local: Application site erythema (2% to 51%), application site irritation (1% to 50%; severe: ≤3%), local skin exfoliation (1% to 49%), application site pruritus (2% to 35%), application site burning (8% to 30%), local desquamation (12%)

1% to 10%:

Dermatologic: Hyperpigmentation (≤2%)

Local: Application site dermatitis (4%), application site pain (1% to 3%)

Frequency not defined: Dermatologic: Skin photosensitivity

<1%, postmarketing, and/or case reports: Contact dermatitis, skin changes (atypical changes in melanocytes and keratinocytes, increased dermal elastosis; treatment lasting >48 weeks)

Contraindications

Hypersensitivity to tretinoin or any component of the formulation. Note: There are no contraindications listed in Altreno, Atralin, or Retin-A Micro US labeling.

Documentation of allergenic cross-reactivity for retinoids is limited. However, because of similarities in chemical structure and/or pharmacologic actions, the possibility of cross-sensitivity cannot be ruled out with certainty.

Warnings/Precautions

Concerns related to adverse effects:

• Fish allergies: Atralin gel contains soluble fish proteins; use caution in patients with sensitivities or allergies to fish.

• Hypersensitivity reactions: Discontinue tretinoin if drug sensitivity, chemical irritation, or a systemic adverse reaction occurs.

• Photosensitivity: Use is associated with increased susceptibility/sensitivity to UV light; avoid or minimize excessive exposure to sunlamps or sunlight. Daily sunscreen (SPF ≥15) use and other protective measures (eg, clothing over treated areas) are recommended. Use with caution in patients with personal or family history of skin cancer.

• Skin irritation: Treatment can increase skin sensitivity to weather extremes of wind or cold. Excessive dryness, redness, and swollen or blistered skin may occur. Also, concomitant topical medications (eg, medicated or abrasive soaps, cleansers, or cosmetics with a strong drying effect) should be used with caution due to increased skin irritation. Depending on the severity of irritation, use a moisturizer, reduce the amount or frequency, or discontinue use until irritation disappears.

Disease-related concerns:

• Eczema: Use with caution in patients with eczema; may cause severe irritation.

Dosage form specific issues:

• Cream 0.02%: Do not use the 0.02% cream for longer than 52 weeks when using for palliation of fine wrinkles.

• Cream 0.05%: Do not use the 0.05% cream for longer than 48 weeks when using for palliation of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin.

• Gel and Stieva-A cream [Canadian product]: Flammable; do not expose to high temperatures or flame.

Other warnings/precautions:

• Appropriate use: For external use only; avoid contact with abraded skin, sunburned skin, mucous membranes, eyes, mouth, angles of the nose. When used for palliation of fine wrinkles, mottled hyperpigmentation, or facial skin roughness, should be used as part of a comprehensive skin care and sun avoidance program.

Warnings: Additional Pediatric Considerations

Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Aminolevulinic Acid (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Systemic). Risk X: Avoid combination

Aminolevulinic Acid (Topical): Photosensitizing Agents may enhance the photosensitizing effect of Aminolevulinic Acid (Topical). Risk C: Monitor therapy

Methoxsalen (Systemic): Photosensitizing Agents may enhance the photosensitizing effect of Methoxsalen (Systemic). Risk C: Monitor therapy

Multivitamins/Fluoride (with ADE): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination

Multivitamins/Minerals (with ADEK, Folate, Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination

Multivitamins/Minerals (with AE, No Iron): May enhance the adverse/toxic effect of Retinoic Acid Derivatives. Risk X: Avoid combination

Porfimer: Photosensitizing Agents may enhance the photosensitizing effect of Porfimer. Risk C: Monitor therapy

Verteporfin: Photosensitizing Agents may enhance the photosensitizing effect of Verteporfin. Risk C: Monitor therapy

Food Interactions

Vitamin A toxicity may rarely occur. Management: Avoid excessive intake of vitamin A (cod liver oil, halibut fish oil).

Reproductive Considerations

These products should not be used in women who are attempting to conceive or at high risk for pregnancy.

Pregnancy Considerations

Adverse events were observed in some animal reproduction studies following topical application of tretinoin. Teratogenic effects were also observed in pregnant women following topical use; however, a causal association has not been established.

When treatment for acne is needed during pregnancy, other agents are preferred (Chien 2016; Kong 2013; Leachman 2006). These products should not be used in women who are pregnant.

Breastfeeding Considerations

It is not known if tretinoin is present in breast milk following topical application.

Tretinoin is an endogenous substance and likely present in breast milk. Although the manufacturer recommends caution when administering tretinoin (topical) to breastfeeding females, the use of topical agents is generally preferred over systemic agents for the treatment of facial acne in women who are breastfeeding; topical tretinoin may be compatible with breastfeeding; however, specific studies are not available. Avoid applying large amounts over prolonged periods of time to decrease the potential for systemic absorption (Butler 2014; Kong 2013; Leechman 2006). Mothers should wash hands following application. Because topical agents can be transferred to a breastfeeding infant, avoid direct skin-to-skin contact with treated areas (Anderson 2018). Use of alternative agents or postponement of therapy may also be considered (Zip 2002). When used for other indications, treatment should be postponed until after breastfeeding is complete (Korgavkar 2015).

Mechanism of Action

Tretinoin is a derivative of vitamin A. When used topically, it modifies epithelial growth and differentiation. In patients with acne, it decreases the cohesiveness of follicular epithelial cells and decreases micromedo formation. Additionally, tretinoin stimulates mitotic activity and increased turnover of follicular epithelial cells causing extrusion of the comedones.

Pharmacokinetics

Onset of action: Acne: ≥2 weeks, may take ≥7 weeks; Facial wrinkles: Up to 6 months

Absorption: Minimal

Bioavailability: Avita cream and gel: <0.3%; Retin A Micro 0.1% gel: ~1%

Metabolism: Hepatic; forms metabolites

Excretion: Urine and feces

Pricing: US

Cream (Avita External)

0.025% (per gram): $5.36

Cream (Refissa External)

0.05% (per gram): $7.04

Cream (Renova External)

0.02% (per gram): $7.91

Cream (Renova Pump External)

0.02% (per gram): $7.60

Cream (Retin-A External)

0.025% (per gram): $4.75

0.05% (per gram): $4.75

0.1% (per gram): $4.75

Cream (Tretinoin External)

0.025% (per gram): $5.02 - $6.38

0.05% (per gram): $5.63 - $7.15

0.1% (per gram): $6.57 - $8.35

Gel (Atralin External)

0.05% (per gram): $15.00

Gel (Avita External)

0.025% (per gram): $5.36

Gel (Retin-A External)

0.01% (per gram): $6.33

0.025% (per gram): $6.33

Gel (Retin-A Micro External)

0.04% (per gram): $26.15

0.1% (per gram): $26.15

Gel (Retin-A Micro Pump External)

0.04% (per gram): $21.96

0.06% (per gram): $21.87

0.08% (per gram): $21.87

0.1% (per gram): $21.96

Gel (Tretinoin External)

0.01% (per gram): $5.32 - $6.75

0.025% (per gram): $5.36 - $6.81

0.05% (per gram): $7.50 - $9.52

Gel (Tretinoin Microsphere External)

0.04% (per gram): $15.00

0.1% (per gram): $15.00

Lotion (Altreno External)

0.05% (per gram): $3.00

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • A-Acido (AR);
  • Aberela (SE);
  • Acetretin (AE);
  • Acfen-A (MX);
  • Acid A Vit (NL);
  • Acnatac (DE);
  • Acne-Free (EG);
  • Acnederm (BG);
  • Acnetin-A (TH);
  • Acretin (EG, QA);
  • Airol (AE, BH, CH, DE, GR, IT, KW, MY, PH, PK, PL, QA);
  • Alten (MY);
  • Avitcid (FI);
  • Betarretin (PE);
  • Cordes VAS (DE);
  • Cosmotrin (BD);
  • Curacne (KW);
  • Derm A (PH);
  • Effederm (FR);
  • Eudyna (EG, MY);
  • Idaman (ID);
  • Ketrel (HK, LB);
  • Li Ling (CN);
  • Locacid (PT, SK);
  • Melavita (ID);
  • Neocare (ES);
  • Nilac (BD);
  • Optimal Gel (ET);
  • Renova (ZA);
  • Retacnyl (CR, DO, GT, HN, KR, MX, MY, NI, PA, PE, PH, SG, SV, TH, VE);
  • Retavit (IL);
  • Retico (ID);
  • Reticrem (CO);
  • Retigel (CO, CR, DO, GT, HN, NI, PA, SV);
  • Retin A (AT, GR, IT, PT);
  • Retin-A (AE, BB, BH, BR, CH, CO, JO, KW, LB, MT, MX, PE, PH, PK, QA, SA, TH, UY, ZA, ZW);
  • Retino-A (IN);
  • Retirides (ES);
  • Retrieve (NZ, SG);
  • Retrieve Cream (AU);
  • Reviderm (ID);
  • Roaccutane (BH, KW, QA, SA);
  • Smooderm (BH);
  • Stieva-A (AU, CL, CO, KR, MX, MY, PY, SG, TH, UY);
  • Stieva-A Forte (MY);
  • T3 Actin (ET, MY, VN);
  • T3Actin (PH);
  • Tracne (HK);
  • Tracnesan (LK);
  • Trena (BD);
  • Trentin (ID);
  • Tretin-A (LK);
  • Trinon (BD)


For country abbreviations used in Lexicomp (show table)
  1. <800> Hazardous Drugs—Handling in Healthcare Settings. United States Pharmacopeia and National Formulary (USP 40-NF 35). Rockville, MD: United States Pharmacopeia Convention; 2017:83-102.
  2. Altreno (tretinoin) [prescribing information]. Bridgewater, NJ: Bausch Health US, LLC; March 2020.
  3. Anderson PO. Topical drugs in nursing mothers. Breastfeed Med. 2018;13(1):5-7. [PubMed 29298085]
  4. American Academy of Pediatrics Committee on Drugs. "Inactive" ingredients in pharmaceutical products: update (subject review). Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
  5. Atralin gel (tretinoin) [prescribing information]. Bridgewater, NJ: Coria Laboratories; August 2013.
  6. Atralin gel (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; August 2014.
  7. Avita (tretinoin) cream [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals; June 2018.
  8. Avita (tretinoin) gel [prescribing information]. Morgantown, WV: Mylan Pharmaceuticals; January 2018.
  9. Butler DC, Heller MM, Murase JE. Safety of dermatologic medications in pregnancy and lactation: Part II. Lactation. J Am Acad Dermatol. 2014;70(3):417. [PubMed 24528912]
  10. Chien AL, Qi J, Rainer B, Sachs DL, Helfrich YR. Treatment of acne in pregnancy. J Am Board Fam Med. 2016;29(2):254-262. [PubMed 26957383]
  11. Eichenfield LF, Hebert AA, Schachner L, Paller AS, Rossi AB, Lucky AW. Tretinoin microsphere gel 0.04% pump for treating acne vulgaris in preadolescents: a randomized, controlled study. Pediatr Dermatol. 2012;29(5):598-604. [PubMed 22712470]
  12. Eichenfield LF, Krakowski AC, Piggott C, et al. American Acne and Rosacea Society. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131 Suppl 3:S163-86. doi: 10.1542/peds.2013-0490B. [PubMed 23637225]
  13. Eichenfield LF, Matiz C, Funk A, Dill SW. Study of the efficacy and tolerability of 0.04% tretinoin microsphere gel for preadolescent acne. Pediatrics. 2010;125(6):e1316-1323. [PubMed 20498178]
  14. Graber E. Acne vulgaris: overview of management. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed February 3, 2022.
  15. Kong YL, Tey HL. Treatment of acne vulgaris during pregnancy and lactation. Drugs. 2013;73(8):779-87. doi: 10.1007/s40265-013-0060-0. [PubMed 23657872]
  16. Korgavkar K, Wang F. Stretch marks during pregnancy: a review of topical prevention. Br J Dermatol. 2015;172(3):606-615. [PubMed 25255817]
  17. Leachman SA, Reed BR. The use of dermatologic drugs in pregnancy and lactation. Dermatol Clin. 2006;24(2):167-197. [PubMed 16677965]
  18. National Institute for Occupational Safety and Health (NIOSH), "NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings 2012." Available at http://www.cdc.gov/niosh/docs/2012-150/pdfs/2012-150.pdf. Accessed January 21, 2013.
  19. Refissa cream (tretinoin topical) [prescribing information]. San Antonio, TX: DPT Laboratories; November 2011.
  20. Renova cream (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; March 2017.
  21. Renova cream (tretinoin) [prescribing information]. Bridgewater, NJ: Bausch Health US, LLC; September 2019.
  22. Retin-A (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals; June 2018.
  23. Retin-A cream, gel (tretinoin) [prescribing information]. Bridgewater, NJ: Bausch Health US, LLC; September 2019.
  24. Retin-A Micro (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals; January 2015.
  25. Retin-A Micro (tretinoin) [product monograph]. Laval, Quebec, Canada: Valeant Canada LP; March 2012.
  26. Retin-A Micro gel (tretinoin) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; October 2017.
  27. Retin-A Micro gel (tretinoin) [product monograph]. Laval, Quebec, Canada: Bausch Health, Canada Inc; September 2020.
  28. Shehab N, Lewis CL, Streetman DD, Donn SM. Exposure to the pharmaceutical excipients benzyl alcohol and propylene glycol among critically ill neonates. Pediatr Crit Care Med. 2009;10(2):256-259. [PubMed 19188870]
  29. Stieva-A (tretinoin) [product monograph]. Mississauga, Ontario, Canada: GlaxoSmithKline Inc; February 2021.
  30. Tretin-X (tretinoin) [prescribing information]. Cumberland, RI: Onset Dermatologics; February 2014.
  31. Tretin-X cream (tretinoin) [prescribing information]. Cumberland, RI: Onset Dermatologies, LLC; March 2014.
  32. US Department of Health and Human Services; Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health. NIOSH list of antineoplastic and other hazardous drugs in healthcare settings 2016. http://www.cdc.gov/niosh/topics/antineoplastic/pdf/hazardous-drugs-list_2016-161.pdf. Updated September 2016. Accessed October 5, 2016.
  33. Vitamin A Acid (tretinoin) [product monograph]. Laval, Quebec, Canada: Bausch Health, Canada Inc; September 2020.
  34. Winston MH, Shalita AR, “Acne Vulgaris, Pathogenesis and Treatment,” Pediatr Clin North Am, 1991, 38(4):889-903. [PubMed 1831256]
  35. Zip C. Common sense dermatological drug suggestions for women who are breast-feeding. Skin Therapy Lett. 2002;7(3):5-7. [PubMed 12007012]
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