How Do Retinoid-like Agents Work?

Retinoids are a class of medications that are derivatives of or related to vitamin A. They are used to treat various inflammatory skin disorders, skin cancer, and skin aging.

Retinoids work in the following ways:

• They bind to and activate retinoic acid receptors (RAR) and retinoid X receptors (RXR).
• These receptors are responsible for regulating cell proliferation, differentiation, and apoptosis (programmed cell death).
• They also play a key role in immune modulation (regulatory adjustment of the immune system) and reduce inflammation.
• Retinoids act on the middle layer of the skin and help neutralize free radicals, which boosts the production of elastin and collagen.
• This results in a plumping effect that reduces fine lines and wrinkles.
• They also have an exfoliating effect on the skin that helps improve skin texture and tone.

Liver function tests and lipid profile of patients taking retinoids should be carefully monitored.

Retinoid-like agents are useful in treating various skin and autoimmune disorders. Conditions where they may be used include:

• Acne vulgaris
• Fine lines and dark spots
• Cutaneous lupus erythematosus (chronic, autoimmune, multisystem disease)
• Lichen planus (an inflammatory skin condition marked by an itchy, bumpy, pink or purple rash)
• Rosacea (a common skin condition that causes redness and visible blood vessels on the face)
• Seborrhea (red, itchy rash, and white scales)
• Freckles (flat small tan or light-brown spots on sun-exposed skin)
• Photoaging (premature skin aging caused by overexposure to the sun's rays)
• Uneven skin texture
• Melasma (a common pigmentation disorder that causes brown or gray patches to appear on the skin, primarily on the face)
• Hidradenitis suppurativa (a skin condition that causes small, painful lumps to form under the skin)
• Scalp folliculitis (an inflammatory disorder of the hair follicles in the scalp)
• Acute promyelocytic leukemia (immature white blood cells called promyelocytes accumulate in the bone marrow)
• Psoriasis (a chronic skin condition that can cause red, scaly patches on the skin)
• Palmoplantar keratoderma (a group of skin conditions characterized by thickening of the skin on the palms of the hands and soles of the feet)
• Pityriasis rubra pilaris (a rare skin disorder that causes inflammation of the skin, thickening of the nails, and at times shedding of the hair)
• Darier’s disease (a skin condition characterized by wart-like blemishes on the body)
• Lichen sclerosus (an uncommon condition that creates patchy, white skin that appears thinner than normal)
• Cutaneous T-cell lymphoma (a rare type of cancer that begins in white blood cells called T cells or T lymphocytes)
• Chronic hand eczema (erythema, vesicles, papules, scaling, fissures, hyperkeratosis, and symptoms of itch and pain)

Side effects are temporary and will likely improve within a few weeks of use.

Common side effects include:

• Redness
• Drying and/or peeling of skin
• Skin hot to touch
• Headache
• Nausea
• Vomiting
• Diarrhea
• Dry mouth
• Hair loss
• Sunburn
• Bone/joint pain
• Pruritis (itching)
• Cheilitis (a condition that manifests as red, dry, scaling, and itchy lips)
• Alopecia (a condition that causes hair to fall out in small patches)

Other rare side effects include:

• Chest discomfort
• Dizziness (feeling faint, weak, or unsteady)
• Anxiety
• Arrhythmia (irregular heartbeat)
• Increase lipids (triglycerides and cholesterol)
• Liver toxicity
• Bleeding gums
• Paronychia (skin infection around a fingernail or toenail)
• Nyctalopia (loss of night vision)
• Depression
• Irritability
• Sleep disturbances
• Hypervitaminosis (abnormally high storage levels of vitamins)
• Decreased hemoglobin level
• Epistaxis (nosebleed)

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Names of some retinoid-like drugs include:  

• Absorica
• Absorica LD
• Acitretin
• Amnesteem
• Claravis
• Isotretinoin
• Myorisan
• Soriatane
• Zenatane